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THE 

CURABILITY  OF  INSANITY 


AND    THE 


Individualized   Treatment  of  the   Insane 


BY 


JOHN  S.  BUTLER,  M.D. 

HARTFORD,  CONN. 


LATE    PHYSICIAN   AND    SUPERINTENDENT   OF   THE    CONNECTICUT   RETREAT    FOR   THE 

INSANE  ;     MEMBER    OF    THE   CONNECTICUT    STATE    BOARD     OF    HEALTH  ; 

HONORARY      MEMBER     OF    THE     MEDICO-PSVCHOLOGICAL 

ASSOCIATION    OF    GREAT    BRITAIN 


NEW  YORK  AND  LONDON 

G.   P.    PUTNAM'S    SONS 

S;^e  Knickerbocker  ^rcss 

1887 


/     r 


COPYRIGHT   BY 

JOHN  S.  BUTLER 


Press  of 

G.  P.  Putnam's  Sons 

New  York 


I 


Insanity  is  a  disease  of  the  brain,  including  a  departure  from 
ordinary  modes  of  thoiight  and  states  of  feeling  in  health. — Dr.  Ray. 

Insanity  is  a  calamity  incident  alike  to  tender  sensibility,  to  grand 
enthusiasm,  to  sublime  genius,  and  to  intense  exertion  of  the  intel- 
lect.— Sir  James  Alacintosh. 

Whoever  has  brought  himself  to  consider  a  disease  of  the  brain  as 
differing  only  in  a  degree  from  a  disease  of  the  lung,  has  robbed 
insanity  of  that  mysterious  horror  which  forms  its  chief  malignity. 
— Sir  y antes  Macintosh — Life  of  Robert  Hall. 

The  physician,  confident  in  the  assurance  that  patient  and  careful 
observation  of  insanity,  with  the  earnest  desire  to  understand  its 
nature,  does  fit  him  to  express  with  authority  the  results  of  his  ex- 
perience, must  not  shrink  from  pronouncing  his  opinion  sincerely  and 
fearlessly,  however  unpopular  it  may  be. — Maudesley  on  Responsi- 
bility in  Mental  Disease. 


lU 


THE    CURABILITY    OF    INSANITY    AND    THE 
INDIVIDUALIZED  TREATMENT  OF 

THE   INSANE. 


IN  the  comparisons  of  the  provisons  made  for  the  in- 
sane in  the  United  States,  in  1844,  with  those  of  the 
present  day,  we  find  the  best  measure  of  progress  to  be  in 
the  larger  recognition  of  their  necessities,  in  remedial 
treatment,  custodial  provision,  and  acceptance  of  the 
power  of  prevention  as  applicable  to  insanity  as  to  other 
physical  diseases. 

In  October,  1844,  thirteen  gentlemen  met  in  Philadel- 
phia and  organized  the  "  Association  of  Medical  Super- 
intendents of  Institutions  for  the  Insane."  Their  object 
was,  by  a  comparison  of  views  and  careful  study,  "■  to 
secure  for  the  future  a  higher  standard  for  hospitals, 
and  a  more  liberal  and  enlightened  treatment  for  all  suf- 
fering from  mental  diseases."  The  causes  which  led  to 
this  result  are  stated  in  the  Secretary's  history  of  the 
Association.  At  that  time,  1844,  there  were  in  the  United 
States  twenty-five  lunatic  hospitals  of  all  classes,  contain- 
ing less  than  twenty-six  hundred  or  twenty-seven  hundred 
inmates.  The  largest  number  in  a  distinct  hospital  was 
two  hundred  and  sixty-three,  in  that  of  Worcester,  al- 
though there  were  three  hundred  and  fifty  in  the  Recep- 


2  THE   CURABILITY  OF  INSANITY. 

tacle  on  Blackwell's  Island.  According  to  the  report  of 
the  Board  of  the  State  Charities  in  Pennsylvania,  in  Sep- 
tember, 1883,  there  were  in  the  United  States  one  hun- 
dred and  foTty-seven  lunatic  asylums,  containing  fifty- 
one  thousand  eight  hundred  and  seventeen  patients ;  the 
total  number  of  insane  in  the  United  Sates  being  esti- 
mated to  be  ninety-two  thousand,  or  one  in  five  hundred 
and  forty-five  of  the  population,  the  lowest  rate  of  insanity 
being  found  in  the  more  recently  settled  States.  The 
Association  at  this  time  embraces  all  North  American 
institutions,  and  now  records  one  hundred  and  twenty- 
two  active  and  retired  members.  Well  may  the  excellent 
and  most  efficient  Secretary  say  of  the  Association  that, 
"  Formed  in  the  interest  and  for  the  promotion  of  the 
welfare  of  the  insane,  it  has  been  steadily  growing  in 
numbers,  in  influence  and  power,  until  it  covers  with 
its  protecting  shield  a  large  proportion  of  the  insane 
throughout  the  length  and  breadth  of  the  land."  In  the 
eventful  history  of  the  Association  for  the  past  forty  years 
there  has  been,  for  the  most  part,  a  singular  and  cordial 
unanimity  of  action  as  to  the  best  means  of  attaining  the 
desired  end — the  highest  good  of  the  insane.  The  "  Propo- 
sitions "  adopted  by  the  Association  show  not  only 
a  large  wisdom,  but  a  foresight  of  the  necessities  of  this 
comparatively  new  and  unexplored  field  of  philanthropy. 
The  unexpectedly  large  and  continually  increasing 
number  demanding  either  hospital  treatment,  or  simply 
hospital  supervision  and  care,  has  naturally  led  to  a  diver- 
sity of  opinion  as  to  the  number  of  patients  that  can  be 
most  profitably  treated  in  one  institution.  That  the  causes 
of  this  diversity  may  l^e  better  understood,  and  my  own 


THE   CURABILITY  OF  INSANITY.  3 

position  more  clearly  defined,  I  may  here  quote  some  of 
these  propositions,  and  my  reasons  for  objecting,  not 
only  to  the  one  accepted  by  a  close  vote,  but  to  the 
others  subsequently  passed  in  accordance  with  it. 

At  the  meeting  in  Philadelphia,  in  1851,  among  other 
propositions,  the  following  was  unanimously  adopted  : 

The  highest  number  that  can,  with  propriety,  be  treated  in  one 
building  is  250,  while  200  is  a  preferable  maximum.' 

At  the  meeting  in  Washington,  in"  1866,  the  following 
propositions  were  adopted  : 

Insane  persons  considered  incurable,  and  those  supposed  curable, 
should  not  be  provided  for  in  separate  establishments. 

****** 

The  large  States  should  be  divided  into  geographical  districts  of 
such  size  that  a  hospital,  situated  at  or  near  the  centre  of  the  district, 
shall  be  practically  accessible  to  all  people  living  within  its  bounda- 
ries, .  .  .  and  available  for  their  benefit  in  cases  of  mental 
disorder. 

All  State,  county,  and  city  hospitals  for  the  insane  should  receive 
all  persons  belonging  to  the  vicinage  designed  to  be  accommodated 
by  such  hospitals,  who  are  afflicted  with  insanity,  whatever  may  be 
the  form  of  the  bodily  disease  accompanying  the  mental  disorder. 

The  enlargement  of  any  such  specified  institution  may  be  properly 
carried,  as  required,  to  the  extent  of  accommodating  six  hundred  pa- 
tients, embracing  the  usual  proportion  of  curable  and  incurable  in  a 
particular  community. 

'  The  International  Record  for  April,  1887,  gives  the  number  of 
inmates  in  each  of  eighty-eight  of  our  lunatic  hospitals.  Of  these 
eighty-eight  hospitals  only  sixteen  contain  not  more  than  250  patients, 
— that  "  highestnumber "  accepted  by  the  Association  in  1851  ; 
thirty-eight  contain  from  250  to  600  ;  twenty-four  from  600  to  1,000  ; 
and  ten  from  1. 000  to  1,818. 

The  complaint  of  the  continued  over-crowding  for  admission 
seems  unabated. 


4  THE   CURABILITY  OF  INSANITY. 

While  the  other  i^ropositions  were  quite  unanimously 
accepted,  this  was  passed,  near  the  close  of  the  meeting, 
by  a  vote  of  eight  to  six.  Under  the  increasing  pressure 
of  necessary  admissions,  this  proposition  has  seemed 
practically  to  annul  any  official  limitation  of  number. 

At  the  meeting  at  Toronto,  in  187 1,  the  Association 
reaffirmed,  in  the  most  emphatic  manner,  all  the  former 
declarations  in  regard  to  hospital  organization,  manage- 
ment, etc.,  and  also. 

Resolved,  That  neither  humanity,  economy,  nor  expediency  can 
make  it  desirable  that  the  care  of  the  recent  and  chronic  insane 
should  be  in  separate  institutions. 

My  own  position  upon  this  point  of  numbers  was  early 
taken,  and  I  have  seen  no  good  reason  to  change.  At 
the  meeting  in  Pittsburg,  in  1865,  I  stated  to  the  Asso- 
ciation that  the  admission  into  the  Retreat  of  a  large 
number  of  incurable  State  patients  had  greatly  embar- 
rassed the  remedial  treatment  of  the  recent  and  hopefully 
curable.  And  I  was,  consequently,  led  to  suggest  the 
consideration  by  the  meeting  of  some  kind  of  distinct 
and  efficient  provision  to  be  adopted  by  the  State  for 
these  unfortunates.  I  did  this  simply,  without  any  dis- 
tinctly formed  plan  of  my  own,  but  only  to  find  the  best 
effectual  way  of  escaping  from  such  possibly  avoidable 
interference  with  hopefully  curable  treatment.  Most 
unexpectedly  to  me,  this  proposition  led,  as  was  reported, 
to  the  "  most  excitable  debate  of  the  session,"  as  unex- 
pectedly, to  its  almost  unanimous  disapproval,  only  one 
member  (Dr.  Hills,  of  Ohio)  voting  with  me  in  favor  of 
it.     I  then  offered  the  following  motion  : 


thp:  curability  of  imsamity.  5 

Resolved,  That  a  committee  of  three  be  appointed  to  take  into 
consideration  the  condition  of  the  chronic  and  supposed  incuiable  in- 
sane, and  the  possible  arrangement  for  their  treatment  and  custody, 
and  to  report  at  the  next  meeting  of  the  Association. 

The  motion  was,  in  due  courtesy,  passed,  and  Drs. 
Butler,  Walker,  and  Curwen  were  appointed  the  com- 
mittee. 

A  long  vacation,  made  necessary  by  illness,  prevented 
both  my  preparation  of  a  report  and  my  attendance  at 
the  next  meeting. 

At  the  meeting  in  1866,  propositions  favorable  to  my 
views  were  presented  by  Dr.  Walker,  and  rejected  ; 
while  others  of  an  opposite  import,  by  Dr.  Chipley,  were 
accepted.  The  unanimous  reaffirmation  of  all  the  propo- 
sitions heretofore  adopted,  clearly  defined  the  decision  of 
the  Association  on  those  points. 

I  hold  that  these  later  propositions  fail  to  anticipate 
the  large  increase  of  the  number  of  the  insane,  the  larger 
hospital  accommodations  they  demand,  and,  especially, 
the  changes  so  rapidly  coming  over  the  different  classes. 
Neither  the  original  thirteen,  in  1844,  nor  the  members 
who  in  1 85 1  voted  that,  "  two  hundred  were  a  preferable 
maximum  of  inmates  to  be  treated  in  one  building," 
could  have  imagined  the  present  number  of  insane,  in 
and  out  of  hospitals,  or  that  its  rapid  increase  would,  in 
a  single  year  (1884)  add  more  than  two  hundred  to  their 
number  in  the  single  State  of  Massachusetts. 

My  proposition  at  the  Pittsburg  meeting  in  1865 
seemed  to  fall  lifeless  from  the  animated  discussion  which 
it  had  excited  ;  but  the  radical  principle  it  contained, 
like  good  seed  sown  by  more  than  one  hand  and  in  good 


6  THE   CURABILITY  OF  INSANITY. 

ground,  has,  after  twenty  years  of  gradual  and  persistent 
development,  come  forward  with  better  promise  of  ac- 
ceptance in  the  future. 

Here,  fairly  to  myself,  I  may  recall  some  of  those 
events  in  my  earlier  professional  life,  which  led  me  to 
determined  opinions  in  regard  to  the  necessities  of  the 
insane. 

Early  in  1833,  shortly  after  I  had  commenced  the 
practice  of  medicine  in  Worcester,  Mass.,  I  made  a  call 
simply  of  professional  courtesy  on  Dr.  Woodward,  who 
had  been  lately  appointed  superintendent  of  the  newly 
erected  State  Lunatic  Hospital.  While  standing  with 
him  in  the  entrance  hall,  a  party  of  his  patients,  "  crazy 
men  "  (then  a  sadly  strange  sight  to  me),  passed  in  from 
a  walk.  The  Doctor  stopped  them  to  give  an  order  to 
their  attendant,  and  my  attention  was  especially  drawn 
to  the  pitiable  appearance  of  the  laggard  of  the  group. 
Feeble  and  emaciated,  he  seemed  to  be  a  hopeless  re- 
mainder of  a  man.  The  Doctor  told  me  he  was  a  young 
Welshman,  Llewellyn  by  name,  as  I  well  remember,  who 
had  come  to  this  country  "  to  pick  up  gold  in  our  streets." 
Unable  to  find  work  or  wages,  hearing  sad  news  from  his 
home  in  Wales,  through  homesickness  he  had  sunk  into 
the  deepest  melancholy.  "  Poor  fellow,"  I  said,  "  his  is 
an  utterly  hopeless  case."  "  By  no  means,"  answered 
Dr.  Woodward.  "  But  I  mean  him,''  pointing  to  Llewel- 
lyn, "he  cannot  recover!"  "I  confidently  expect  he 
will,"  replied  Dr.  W.  "  May  I  see  your  treatment  ? "  I 
asked.  "  Every  day,  if  you  wish,"  was  the  Doctor's  re- 
ply. For  weeks  following  I  saw  him,  if  not  every  day, 
very  frequently.     On  my  return  home  I  said  to  a  friend  : 


THE   CURABILITY  OF  INSANITY.  / 

"  In  my  course  of  lectures  in  the  Harvard  Medical 
School,  in  my  graduate  and  post-graduate  courses  in 
Philadelphia,  I  heard  no  such  case  described.  In  a  li- 
brary fairly  well  stocked  for  that  day  and  faithfully  con- 
sulted, no  such  case  and  treatment  were  given.  If 
Llewellyn  can  be  cured  it  will  be  next  to  a  revelation  in 
medicine  to  me."  In  a  few  weeks  he  came  down  to  my 
office  to  bid  me  a  grateful  good-bye,  etc.,  there  present- 
ing himself,  in  contrast  with  my  first  interview,  a  rarely 
good  specimen  of  a  healthy,  vigorous,  and  intelligent 
young  man.  This  case  shaped  the  future  of  my  profes- 
sional life.  For  years  afterwards  I  was  a  frequent  visi- 
tor to  the  hospital  and  a  somewhat  careful  observer  in 
the  wards,  to  all  of  which  Dr.  Woodward  gave  me  free 
access.  In  those  wards  I  saw  frequent  illustrations  of 
the  marvellous  results  of  the  moral  treatment  of  the  in- 
sane— that  individualized  power,  which  the  healthy,  in- 
telligent, enthusiastic  mind  holds  over  the  "  untuned  and 
jarring  senses  "  of  the  lunatic.  Then  a  young  practition- 
er, striving  to  win  public  confidence  and  position,  I  found 
that  I  gave  to  my  cases  of  typhus  fever,  etc.,  no  more 
frequent,  sharp,  and  kindly  treatment  than  Dr.  Wood- 
ward gave  to  his  cases  of  recent  insanity.  This,  espe- 
cially, was  before  the  first  enlargement  of  the  Hospital  by 
the  addition  of  two  new  wings,  which  Dr.  Woodward 
greatly  regretted,  being  confident  it  would  cripple  his 
system  of  treatment.  He  earnestly  advised  that  it  should 
be  as  an  "annex"  erected  on  the  adjacent  farm  land  of 
the  Hospital. 

In  1839  I  was  elected  Resident  Medical  Officer  of  the 
Penal,    Charitable,  and    Reformatory    Institutions,   and 


8  THE   CURABILITY  OF  INSANITY. 

superintendent  of  the  newly  erected  Lunatic  Hospital,  of 
the  city  of  Boston.  Those  three  years'  superintendency 
of  the  Lunatic  Hospital  gave  me  the  desired  opportunity 
of  applying  to  my  own  cases  of  insanity  those  principles 
of  treatment  which  I  had  seen  applied  with  such  eminent 
success  in  Dr.  Woodward's  wards,  a  success  which  I  have 
never  seen  surpassed,  if  equalled  ;  a  fascinating  illustra- 
tion to  me,  of  the  merciful  advances  in  these  later  days 
from  the  ignorance  and  cruel  barbarism  in  the  "  mad 
houses  "  of  "  ye  olden  times,"  when,  in  the  language  of 
an  old  Scotch  writer  :  "  The  better  sort  of  ye  mad  people 
were  given  to  the  care  of  the  chirurgeon,  the  baser  sort, 
to  the  taming  of  the  scourge  !  "     See  Appendix  (i). 

The  North  American  Revieiv^  for  January,  1843,  has  an 
article  on  "  Insanity  in  Massachusetts."  The  writer  says  : 
"  We  select  for  description  the  Boston  Lunatic  Hospital  in 
1842.  Its  patients  are  wholly  of  the  pauper  class.  Its  in- 
mates are  of  the  worst  and  most  hopeless  class  of  cases. 
They  are  the  raving  madman  and  the  gibbering  idiot, 
whom,  in  the  language  of  the  inspectors  of  prisons,  hos- 
pitals, etc.,  for  Suffolk  County,  we  had  formerly  seen 
tearing  their  clothes  amid  cold,  lacerating  their  bodies, 
contracting  most  filthy  habits,  without  self-control,  unable 
to  restrain  the  worst  feelings,  endeavoring  to  injure  those 
who  approached  them,  giving  vent  to  their  irritation  in  the 
most  passionate,  profane,  and  filthy  language,  fearing  and 
feared,  hating  and  almost  hated.  Now  they  are  all  neatly 
clad  by  day  and  comfortably  lodged  in  separate  rooms 
by  night.  They  walk  quietly  with  self-respect  along  their 
spacious  and  airy  halls,  or  sit  in  listening  groups  around 
the  daily   paper,  or  they  dig  in  the  garden,  or  handle 


THE    CURABILITY   OF  INSANITY.  9 

edged  tools,  or  stroll  around  the  neighborhood  with  kind 
and  careful  attendants.  They  attend  daily  and  rever- 
ently upon  religious  exercises  and  make  glad  music  with 
their  united  voices.  Such  is  the  condition  of  the  insane 
of  the  city  of  Boston  ;  and  although  but  twenty-eight  out 
of  one  hundred  and  seventy-one  have  been  cured,  and 
the  rest  will  probably  wear  out  their  lives  in  hopeless  in- 
sanity, yet  there  is  a  melancholy  pleasure  in  witnessing 
the  great  amount  of  animal  happiness  they  enjoy,  in  see- 
ing the  kind  regard  paid  to  prostrate  humanity,  the  re- 
spect shown  to  the  deserted  temple  of  reason.  It  is  only 
as  it  were  twining  fresh  flowers  on  the  graves  of  the  dead  ; 
still  it  is  a  grateful  sight  to  the  humane,  and  a  more  cer- 
tain indication  of  high  civilization,  than  the  most  refined 
taste  in  literature  and  the  arts,  or  the  most  fastidious  of 
social  etiquette." 

One  of  these  patients  came  into  the  hospital  out  of  an 
iron  cage,  which  I  was  told  she  had  inhabited  more  than 
a  year,  and  several  others  out  of  veritable  Barnum's  me- 
nagerie wooden  cages.  All  these  were  females.  Freed 
from  restraint  and  seclusion,  soon  after  admission,  they 
were  all  readily  won  over  to  decent  and  orderly  lives. 
Before  long  all  of  them  were  occasional  visitors  in  our 
own  family  parlor.^     I  trust  these  details  will  not  be  con- 

'  Among  the  pauper  lunatics  admitted  late  in  the  autumn  of  1839 
into  the  recently  organized  Boston  Lunatic  Hospital,  and  whose  con- 
dition was  so  graphically  and  truthfully  described  in  the  N'orth 
American  Review  for  January,  1843,  in  the  article  on  "  Insanity  in 
Massachusetts,"  was  a  Scotch-Irish  girl  named  Mary.  She  was  a 
fair  specimen  of  the  repulsive  and  difficult  class  which  first  occupied 
those  wards. 

Mary  was  unusually  athletic,  naturally  good-natured,  but  trained  to 
the  necessity  of  fighting  her  own  way,  and  yielding  only  to  brute 


lO  THE    CURABILITY  OF  INSANITY. 

sidered  outside  of  good  taste,  as  they  seem  to  me  to  be 
but  fairly  descriptive  of  the  natural  outgrowth  of  due 
sympathy  with  the  insane,  as  instructed  and  fortified  by 
the  teachings  and  examples  of  Dr.  Woodward  and  others. 
On  my  election,  early  in  1843,  to  the  superintendency 
of  the  Connecticut  Retreat  for  the  Insane,  I  found  that 
the  directors  had  most  charitably  voted  to  admit,  and  at 
very  low  rates,  many  of  the  pauper  and  chronic  insane 
from  the  almshouses  of  the  State.  In  these,  the  earlier 
days  of  my  Retreat  life,  when  our  crowded  wards  crip- 


force.     Her  untamed  and  belligerent  state  was  the  natural  result  of 
her  sadly  neglected  mental  condition. 

One  day,  passing  by  the  outer  door  of  her  ward,  my  attention  was 
attracted  by  the  unusual  brightness  of  a  dandelion  flower  which  on 
that  cold  autumn  day  had  crowded  its  unseasonable  (but  as  it  proved 
its  timely)  way  up  through  the  lately  graded  ground.  As  I  picked  it 
up  I  was  startled  by  a  wild  uproar  within  the  ward.  Hastening  in, 
I  met  the  frightened  and  then  utterly  inexperienced  nurse,  and,  ap- 
prehending some  serious  trouble,  sent  her  to  hurry  up  an  assistant  of- 
ficer to  my  possibly  needed  aid.  I  have  never  imagined  a  more  strik- 
ing illustration  of  an  old  time  mad-house  than  that  crowded  hall 
then  presented  to  me.  Mary,  her  stout  arms  akimbo,  was  marching 
down  the  hall,  her  voice  at  the  highest  pitch,  profanely  denouncing 
everj'body  and  every  thing  ;  the  other  patients  highly  excited,  some 
running  for  shelter,  others  joining  the  wild  uproar.  I  announced  my 
advent  by  a  decided  stamp  on  the  floor,  with  an  equally  decided 
voice,  saying  :  "  I  will  not  have  such  a  tumult  here."  "  The  h — 1  you 
won't  !  we  '11  see  to  that,"  I  very  distinctly  remember  was  her  prompt 
answer,  as,  suddenly  wheeling,  she  advanced  to  the  decision  of  that 
question  by  "  force  of  arms," — arms  to  which  mine  would  be  but 
feeble  impediments  !  How  heartily  did  I  then  wish  myself  Ijack  in 
general  practice,  out  among  the  sick  and  wounded  Irish  7ne7i  on  the 
railroads  !  But  seemingly  the  supremacy  of  the  week-old  superin- 
tendent was  then  and  there  to  be  fought  out  on  the  instant  !  Re- 
calling the  experience  of  my  boyhood  when,  wrestling  with  the  stouter 
farmer  boys,  I  learned  that  a  sudden  catch  at  the  collar  and  as  quick 
a  rap  at  the  heels  gave  me  the  right  relative  position  in  the  downfall, 
I  waited,  silently  and  quietly  watching  her  ferociously  maddened  ap- 
proach !     When  just  within  reach  suddenly  her  whole  aspect  changed 


7'HE    CURABILITY  OF  INSANITY.  II 

pled  my  means  of  classification,  a  quiet  and  apparently 
inoffensive  case  of  dementia  was  necessarily  located  in 
one  of  the  better  wards  ;  the  poor  man  would  sit  silent 
all  day  in  a  dreamy,  stupid  state,  his  only  token  of  active 
life,  the  constant  twirling  of  his  thumbs.  A  refined  and 
intelligent  gentleman  on  the  same  hall,  who  was  recover- 
ing from  the  results  of  an  overworked  brain,  came  to  me 
one  day,  exclaiming  with  no  little  agitation,  "  Doctor,  I 
nmst  go  home  !  "  I  remonstrated,  urging  his  rarely  good 
prospects  of  a  speedy  recovery.     "  Why  should  you  go  ? " 


and  wonderfully  softened.  Naturally  following  her  eye,  and  looking 
downward,  for  the  ally  who  had  so  suddenly  come  to  my  relief,  I 
found  my  hand,  unconsciously  upraised  for  the  encounter,  held  that 
dandelion  !  I  offered  it  to  her  in  a  few  low-toned  words,  and  she 
accepted  it  with  a  very  humble  courtesy.  The  sudden  and  wonder- 
ful change  of  aspect  was  only  surpassed  by  the  touching  pathos  with 
which  the  subdued  maniac  exclaimed:  "Oh!  beautiful!  can  j^m 
mane  to  give  that  to  the  loikes  of  me  ?  "  The  battle  was  fought  and 
won.     Taking  my  offered  arm,  she  went  quietly  to  her  room. 

There  was  another  chapter  in  the  history  of  poor  Mary,  which 
may  well  be  recorded.  A  few  days  after  my  instructive  experience 
with  the  dandelion,  she  tore  up  the  new  dress  given  her  on  admis- 
sion. After  due  reproof  and  persuasion,  her  promise  of  future  good 
behavior  was  accepted,  and  another  dress  ordered.  "  Why,  sir,  she 
will  certainly  tear  it  up  !  "  said  the  nurse.  "  Then  give  her  an- 
other, and,  if  need  be,  another,"  was  my  answer.  Much  to  my  dis- 
appointment, one  or  two  more  soon  followed  the  first.  My  repeated 
expressions  of  surprise  and  sorrow,  with  kindly  remonstrance  against 
such  unprovoked  bad  behavior,  followed  by  seclusion  in  her  room, 
and  withdrawal  of  my  daily  and  kindly  personal  attentions,  soon 
produced  the  desired  effect,  namely,  more  self-control  and  a  better 
mind.  I  then  gave  her  a  pretty  dress  pattern, — "  good  enough  for  a 
lady,"  she  said, — and  allowed  her  to  help  make  it  up.  We  all  gave 
her  a  somewhat  formal  reception  on  her  "  coming  out  "  in  it  ;  and 
our  comments  were  cordially,  and  Avith  no  little  self-complacency, 
received.  From  that  time  she  became  quiet  and  industrious,  an 
orderly  attendant  on  chapel  services,  and  at  our  little  social  parties. 

Hopelessly  insane,  she  remained  in  an  orderly,  submissive,  and 
seemingly  happy  condition  while  under  my  protective  care, 


12  THE   CURABILITY  OF  INSANITY. 

I  asked.  "  Because,"  said  he,  "  this  continued  rainy 
weather  has  kept  me  in-doors  for  a  fortnight.  I  am  in 
your  way,  in  your  business  rooms.  I  have  worn  out  the 
hospitality  of  Mrs.  Butler — up  there,  seeing  that  poor  old 
fellow  twirling  his  thumbs  hour  after  hour  !  day  after 
day  !  I  can't  stand  it  !  D — n  it,  I  shall  be  just  like 
him  !  "  My  continued  experience  ever  afterwards 
strengthened  my  convictions  of  the  expediency  and  in- 
deed humanity  of  the  segregation  of  the  chronic  insane 
from  the  recent  and  hopefully  curable  cases.  I  was 
compelled  by  this  conviction  to  present  this  question  to 
the  consideration  of  the  Association  at  the  meeting  at 
Pittsburg,  in  1865. 

Individualized  treatment  is  called  for  in  insanity  as 
imperatively  as  in  the  case  of  acute  forms  of  other  physi- 
cal disease.  The  form  of  treatment  is  different  according 
as  the  practitioner  is  hopefully  working  for  a  cure  in  an 
acute  case,  or  as  in  some  chronic  case  of  long  standing, 
he  is  simply  administering  palliation  and  general  care. 
The  first  requires  his  personal  and  persistent  attention, 
the  second  may  be  treated  in  a  general  way  and  may  be 
committed  to  others. 

I  believe  strictly  recent  insanity  in  very  many  cases,  is 
radically  curable  under  the  prompt,  persistent,  and  united 
use  of  medical  and  moral  means.  These,  to  be  efficient? 
demand  individualized  application,  /.  <?.,  that  same  im- 
mediate, close,  and  sharp  personal  service  which  the  gen- 
eral practitioner  necessarily  gives  to  the  early  stages  of 
typhus,  diphtheria,  cholera,  etc.  This  power,  essential  to 
the  largest  success,  is  limited,  as  in  all  individual  efforts, 
by  number.  Applicable  to  the  few,  it  cannot  be  extended 


THE   CURABILITY  OF  INSANITY,  1 3 

to  the  many.  While  here  and  there  it  may  reach  one  in 
a  crowd,  the  general  result  proves  the  limitation.  In  ad- 
dition to  professional  skill  the  largest  success  of  individ- 
ualism demands  that  combination  of  those  innate,  inher- 
ent qualities  of  "  courage,  kindness,  and  patience  "  which 
the  Edmbui'gJi  Review^  in  April,  18 14,  attributed  to  Wil- 
liam Tuke  as  the  secret  of  his  success  in  the  Retreat  for 
the  Insane  in  York,  a  "  success  "  which  remains  to  this 
day  our  highest  instruction  !  As  no  two  cases  of  insanity 
or  physical  disease  are,  in  all  causes  and  effects,  precisely 
alike,' the  peculiarities  of  each  will  of  course  demand 
special  consideration. 

Dr.  Conolly,  in  his  admirable  essay  on  the  "  Indica- 
tions of  Insanity,"  speaking  of  the  duties  of  medical  men, 
says  (page  428)  : 

To-  superintend  with  care  and  without  offending  ;  to  control  with- 
out severity,  and  to  indulge  without  weakness  ;  to  attract  without 
fatiguing  the  attention  ;  to  revive  the  memory  without  reviving  memo- 
rials of  affliction  ;  to  touch  the  imagination  but  not  too  sensibly  ;  to 
encourage  at  favorable  moments  to  such  comparisons  as  may  triumph 
over  retreating  delusions,  is  a  task  too  delicate,  too  sacred,  I  might 
say,  to  be  entrusted  to  common  hands.  It  is  a  power  which  cannot 
be  delegated.^ 

^  Esquirol  relates  that  an  old  nun,  formerly  employed  in  the  tuition 
of  the  young,  was  brought  to  the  hospital  in  a  state  of  profound 
melancholy.  During  six  months  all  the  methods  which  we  had  re- 
course to  were  without  effect.  Her  notions  always  remained  the 
same,  and  she  continually  repeated  to  the  superintendent  that  he 
was  wrong  not  to  treat  her  as  the  most  guilty  of  women,  and  that  he 
ought  to  impose  on  her  the  severest  punishments. 

One  day  she  met  him  in  the  interior  of  the  hospital,  and  renewed 
the  same  kind  of  conversation.  She  received  from  him  a  sharp  reply, 
with  an  express  declaration  that  he  would  listen  to  her  no  more, 
since  she  always  persisted  in  the  same  notions,  and  showed  him  no 
sort  of  confidence.   The  patient  retired  in  silence  to  her  apartment,  re- 


14  THE   CURABILITY  OF  INSANITY. 

The  best  definition  of  the  alleged  power  of  individual- 
ism to  charm  down  insanity,  is  that  given  by  Emerson  as 
"  The  power  b e /mid  th.Q  eye." 

fleeted  deeply  on  the  reproof  she  had  experienced,  and  did  justice  in 
her  own  mind  to  the  upright  and  irreproachable  character  of  the  super- 
intendent, and  his  sincere  desire  to  assist  in  the  re-establishment  of  the 
unhappy  persons  about  him.  Was  not  all  he  had  said  dictated  by 
the  most  humane  intentions  ?  She  experienced  great  perplexity  that 
night,  and  a  sort  of  interior  conflict  between  the  thought  of  her 
imaginary  crimes  and  the  friendly  remonstrance  of  a  man  who  could 
have  no  personal  interest  in  what  he  said.  These  vacillations,  and 
this  interior  conflict,  going  on  for  some  time  in  the  form  of  cool  dis- 
cussion in  her  own  mind,  produced  the  most  favorable  change  in  her, 
and  she  ended  by  being  fully  convinced  that  her  scruples  were  chi- 
merical, and  she  at  once  entered  eagerly  upon  the  proper  means  for 
the  perfect  re-establishment  of  her  health  by  the  proper  physical 
treatment. 

The  preceding  case  reminds  me  of  one  of  my  old  patients  whose 
history  on  admission  told  of  long  time  duration  of  persistent  antago- 
nism in  the  varied  relations  of  her  life.  She  was  a  widow  of  middle 
age,  without  living  children  ;  of  superior  natural  intellectuality  and 
refinement,  and  a  quick  pleasant  manner.  Neglect  in  childhood,  and 
defective  training  in  later  life  led  to  the  natural  consequences  of  the 
undue  indulgence  of  a  strong  will.  These,  added  to  unhappy  domestic 
relations  and  ill  health,  readily  induced  insanity,  though  not  of  a 
marked  salient  character.  In  due  time  and  manner  I  kindly  and 
frankly  discussed  with  her  the  whole  sad  story  of  these  unhappy 
causes  and  effects,  explaining  their  direct  action  upon  her  nervous 
system.  I  urged  my  hearty  desire  for  her  cordial  acceptance  of  my 
professional  opinions,  and  her  cooperation  in  what  my  every-day  ex- 
perience taught  me  was  her  only  way  of  escape.  The  result  of  thus 
winning  her  confidence  and  sympathy,  was  a  gradual  but  decided 
gain  in  general  health  and  better  self-control.  Her  "  fallings  from 
grace  "  became  less  frequent  and  marked.  Some  time  afterward  to 
my  great  surprise  and  annoyance  she  came  to  me  one  day  during  a 
temporary  disturbance  of  her  health,  abruptly  demanding  an  entire 
change  in  my  medical  prescriptions.  I  declined,  pleasantly  explain- 
ing the  good  working  of  the  present  remedy,  and  the  peril  of  the  ex- 
treme one  she  proposed.  She  persisted  in  demanding  the  change.  I 
sought  to  avoid  the  discussion,  but  in  vain  ;  the  difference  of  opinion 
finally  culminating  in  her  saying  with  marked  emphasis  :  "  I  know 
my  own  case,  sir,  and  I  will  have  it  " ;  and  in  my  answering  with  all  the 
then  possible  courtesy  :   "  Madam,  you  compel  me  to  say  you  shall 


THE    CURABILITY  OF  INSANITY.  1 5 

The  chapel/  the  amusement  hall,  the  social  circle  in- 
side and  the  social  circle  outside  of  hospital  wards  have, 
in  my  experience,  proved  potent  remedial  agencies.    Un- 


not  have  it."  She  left  the  room  with  a  defiant  expression,  which, 
shadowing  my  good  hopes  of  her  improvement,  made  me  much  soHci- 
tude.  I  found  next  morning  a  letter  from  her  on  my  desk.  I  opened 
it  with  no  little  anxiety  and  reluctance,  knov/ing  the  peremptory 
power  of  her  pen.  I  expected  a  sharp  continuance  of  her  argument  ; 
but  I  gladly  accepted  her  conclusion  when  I  read, 

"  My  dear,  dear — Emperor  Nicholas  : — Forgive  me — forgive  me 
— I  will  try  never  to  be  so  naughty  again." 

A  young  lady  between  sixteen  and  seventeen  years  of  age,  of  good 
physical  development,  but  apparently  of  a  decidedly  ner\'ous  tempera- 
ment, lady-like  in  her  present  manners,  was  some  time  ago  placed 
under  my  care.  Her  parents  told  me  that  she  had  been  in  pretty  good 
health  until  within  a  year  or  two,  when  without  any  apparent  cause 
she  had  become  dyspeptic,  oftentimes  sleepless,  generally  unwell,  and 
gradually  growing  worse  and  more  nervous  and  excitable.  She  had 
of  late  become  so  uncontrollable  that  they  were  compelled  to  bring 
her  to  the  Retreat,  fearing  she  was  drifting  into  insanity.  As  she  was 
their  only  child,  they  now  feared  that  they  had  been  unwisely  indul- 
gent to  her. 

Her  heartless  indifference  to  the  separation  from  her  parents 
plainly  indicated  the  "  spoiled  child." 

A  careful  investigation  of  her  case  enabled  me  readily  to  detect 
the  disordered  condition  of  various  organs,  a  condition  easily  pre- 
ventible  in  its  primary  stages,  and  now  as  easily  remedied  by  suita- 

'  ' '  Though  it  is  the  first  time  for  years  that  many  of  our  inmates  had 
been  thus  recognized  as  members  of  the  human  family,  their  fixed  at- 
tention and  serious  deportment  is  a  pleasant  illustration  of  the  adapta- 
tion of  the  Gospel  to  '  all  sorts  and  conditions  of  men.'  The  utility 
of  its  influences  should  be  undoubted.  No  one  can  look  upon  our 
household  assembled  for  the  instruction  of  the  Sabbath,  or  for  the 
family  worship  of  the  evening,  and  see  them  there  as  one  family  rise 
up  silently  and  reverently  to  pray  to  '  Our  Father  in  Heaven,'  with- 
out realizing  that  some  feel  the  solemnity  of  the  act,  without  being 
convinced  that  a  clford  may  be  struck,  whose  ultimate  vibration  may 
awaken  some  recollection  of  early  life  and  bring  back  upon  the  ex- 
cited and  bewildered  mind  some  calm  and  solemn  influences,  and  give 
that  one  moment  of  self-control  in  which  the  first  link  in  the  chain 
of  diseased  associations  may  be  broken." — Boston  Lunatic  Hospital 
Report,  1840. 


1 6  THE   CURABILITY  OF  INSANITY. 

der  such  influences  I  have  frequently  detected  the  first 
indications  of  recovery.  It  seems  self-evident  to  me  that 
these  details  of  moral  treatment  can  be  most  successfully 
applied  only  in  a  hospital  of  the  originally  assumed  "best 
number  "  of  two  hundred  inmates.  Here  can  be  most 
easily  developed  those  social  influences  which  have  such 
special  power  over  diseases  of  the  brain  and  nervous 
system.  In  such  comparatively  secluded  lives,  the  nat- 
ural cravings  for  sympathy  and  companionship  most 
readily  attract  those  genial  affinities  which  lead  to  the 
formation  of  little  homelike  circles  of  newly  found 
friends.  The  happiest  results  can  often  be  traced  from 
such  circles.  The  reaction  of  mind  upon  mind,  compari- 
son and  discussion,  with  criticisms,  sometimes  happily 
sharp  they   may  be,   but   ever   kindly,   have    here    their 


ble  remedial  agencies, — another  of  the  familiar  and  sad  old  stories  of 
neglected  cause  and  effect. 

As  she  appeared  pleasant  and  lady-like,  and  quietly  accepted  her 
novel  position,  I  located  her  with  others  of  my  lady  patients,  natu- 
rally expecting  that  the  regaining  of  self-control  would  be  aided  by 
the  influence  of  such  refined  and  genial  surroundings. 

For  a  few  days  all  went  so  well  with  her  that  I  was  beginning  to 
think  her  parents  had  been  needlessly  alarmed.  But  the  little  stock 
of  self-control  was  soon  exhausted,  even  under  the  soothing  influence 
of  the  new  surroundings,  when  I  was  summoned  hastily,  the  nurse 
reporting  a  violent  outbreak  of  temper  on  slight  provocation,  and  the 
free  use  of  language  "  too  bad  to  be  repeated  to  you."  On  reaching 
the  hall,  assuming  the  appearance  of  great  regret  and  mortification, 
I  told  the  ladies  that  I  came  up  to  apologize  for  the  sad  blunder  I 
had  made  in  associating  that  ' '  unfortunate  young  woman  "  with  them. 
From  the  social  position  of  her  j^arents  I  had  unfortunately  taken  it 
for  granted  that  their  daughter  was  a  young  lady,*  asking  them  to  ex- 
cuse my  mistake,  and  directing  "the  young  woman  "  to  follow  me. 
I  immediately  took  her  down  to  a  lower  department,  occupied  by  a 
sadly  repulsive  class,  whom  the  charity  of  our  Board,  before  the 
erection  of  the  State  hospital,  had  temporarily  received  from  the  alms- 
houses  of  the  State.     Bidding  the  nurse   to  be  very   patient  with 


THE   CURABILITY  OF  INSANITY.  1 7 

place.  The  desponding  are  comforted  and  made  hope- 
ful, and  the  excited  are  repressed  and  instructed  by  the 
cordial  and  kindly  comments  of  the  convalescent  and  ex- 
perienced. If  all  these  desired  good  effects  do  not  /;;/- 
mediately  YQ^\i\t,  they  certainly  remove  at  once  that  greatest 
evil  of  lunatic  hospitals — monotony.  Dr.  Tuke,  in  his 
admirable  "  Illustrations  of  the  Influence  of  the  Mind 
upon  the  Body,"  speaking  of  the  importance  of  this 
power  as  a  practical  remedy  in  disease,  quotes  John 
Hunter,  as  follows  : 

There  is  not  a  natural  action  in  the  body,  whether  voluntary  or 
involuntary,  that  may  not  be  influenced  by  the  special  state  of  the 
mind  at  the  time. 

The  variety  of  ways  by  which  one  may  promote  the 
interest  of  the  insane,  happily  illustrates  the  many-sided- 
ness of  truth. 

this  sad  addition  to  her  burdensome  family,  to  shut  her  up  in  a  room 
if  her  language  became  intolerable,  I  left  her  with  no  little  anxiety 
as  to  the  result  of  this  "  moral  treatment." 

In  a  brief  time  I  was  earnestly  recalled,  the  nurse  reporting  that 
the  young  lady,  in  a  paroxysm  of  tears,  repentant  of  her  folly,  ad- 
mitting my  just  decision,  was  begging  the  privilege  of  my  forgive- 
ness. Accepting  her  sincere  repentance  with  great  delight,  and 
bidding  the  nurse  to  readjust  her  dress,  and  to  remedy  the  flushed 
and  tearful  face  with  a  little  cold  water,  I  gave  the  girl  my  arm  and 
returned  to  the  hall..  Entering  the  room  with  much  assumed  formali- 
ty, I  introduced  my  companion  as  "  a  charming  young  lady  friend  of 
mine,  who  had  just  come  up  to  us  from  the  country."  The  ladies 
readily  appreciating  our  position,  gave  their  returned  associate  a 
right  merry  and  hearty  reception.  From  that  time  forth  her  progress 
toward  recovery  Avas  satisfactory.  Her  physical  ailments  gave  way 
to  simple  remedies.  The  power  of  self-control  without  a.Tiy  serious 
interruptions  returned,  and  under  its  carefully  persistent  cultivation 
advanced  to  its  natural  and  sufflcient  development.  On  leaving  us  she 
said,  "  lam  well,  and  shall  keep  so  ;  thanks,  you  have  taught  me  the 
necessity  of  self-denial.  For  the  first  time  in  my  life  I  have  been 
made  to  obey." 


1 8  THE   CURABILITY  OF  INSANITY.  __ 

The  same  appliances  that  tend  to  make  life  in  a  well- 
ordered  house  beautiful  and  happy,  may  be  brought  to 
bear  upon-  the  disordered  mind  ;  and  its  wanderings  and 
vagaries  be  arrested  by  putting  it  as  nearly  as  possible  in 
relations  like  those  of  private  secluded  home-life.  The 
great  caravansaries  we  call  hotels  are  not  homes,  neither 
do  the  immense  structures  we  build  as  hospitals,  however 
well  kept,  tend  to  promote  the  home  content,  and  to 
awaken  those  sweet  and  restorative  feelings  that  belong 
to  home  itself.' 

^  Some  years  ago,  a  young  lady  of  about  seventeen  years  of  age, 
of  delicate  organization,  sensitive  and  nervous,  and  in  frail  general 
health,  was  brought  from  a  distant  city  to  our  care  by  her  only  and 
older  sister. 

They  had  been  left  motherless  at  an  early  age.  The  neglect  of 
rightful  early  training,  the  varying  impulses  of  a  wayward  will,  some 
sad  hygienic  mistakes — the  result  of  educational  neglect, — made  her 
committal  to  the  Retreat  a  discreet  and  timely  measure. 

After  the  formalities  of  admission,  the  sister,  after  giving  the  out- 
line of  her  case,  besought  me  to  give  some  little  extra  attention  to 
my  new  patient.  "  It  is  a  terrible  thing,  sir,"  she  said,  "  to  leave  this 
poor,  sick,  dear  child,  hundreds  of  miles  from  home,  all  alone  among 
strangers."  I  was  ready  to  promise  what  she  wished,  hopingin  some 
way  to  allay  the  not  unnatural  nervous  excitement  of  both. 

After  expediting  their  separation,  I  told  the  young  lady  that,  being 
now  under  my  professional  care,  she  could  better  tell  me  all  about 
her  troubles  somewhere  out  on  the  lawn.  There,  surrounded  by 
those  soothing  influences  which  I  have  so  often  found  efficient  aids 
to  professional  treatment,  I  at  first  led  her  attention  to  our  beautiful 
surroundings  rather  than  to  the  details  of  her  ailments,  calling  her 
attention  to  the  varied  scenery,  the  pleasant  changes  of  light  and 
shade,  and  to  the  flowers  of  which  she  seemed  so  fond  ;  occasionally 
alluding  to  the  events  of  her  long  journey,  and  casually  asking  lead- 
ing questions  aljout  her  health, — all  this  with  the  pleasant  result  of 
gradually  substituting  self-control  and  smiles  for  nervous  agitation 
and  tears.  The  songs  of  the  birds  attracted  her  attention.  "  I  am 
so  fond  of  music,"  she  said.  This  I  was  glad  to  hear,  as  we  had  so 
many  musical  parties.  Disclaiming  the  rare  musical  merit  I  had 
heard  she  f)Ossessed,  as  I  called  for  evidence,  it  came  first  in  sad, 
and  ]jy  and  by  in  merrier,  notes.     The  noon-day  bell  put  an  end    to 


THE   CURABILITY  OF  INSANITY.  19 

"  How  clean  and  nice  this  room  is,"  said  a  director  to 
me,  one  day,  in  one  of  the  old,  rigidly  plain  halls,  long 
before  the  reconstruction.  "  Yes,"  I  answered,  "  the 
floor,  the  bed,  the  walls  are  white — if  not  white  as  snow 
— white  enough  to  chill  the  heart  of  the  delicate,  refined 
young  mother  who  is  to  occupy  it  to-day."  "Why,  what 
better  would  you  have  ? "  he  asked.  "  All  possible  home- 
like ornamentation,  neutral  tints,  pictures,  flowers,  etc., 
etc.  ;  every  thing  to  give  the  room  an  inviting  aspect,  and 
not  painfully  to  remind  her  of  that  refined  and  home-felt 

our  pleasant  out-of-door  visit.  "  What  is'that  for  ?  "  she  asked.  "  It 
is  noon,  and  we  must  go  in  to  get  ready  for  dinner,"  I  told  her. 
"  Noon  !  "  she  exclaimed,  "  how  strange,  how  really  absurd  !  why, 
a  little  while  ago  to  be  left  here  all  alone,  was  to  break  my  heart,  and 
now  I  have  been  singing  and  laughing  with  you."  Then  came  my 
sought  opportunity.  "  No,  this  is  nothing  absurd  ;  all  this  is  hope- 
ful to  me  ;  you  have  given  me  the  keynote  to  the  history  of  your 
illness  ;  this  gives  good  promise  of  your  restoration  to  health  and 
a  happy  future,  if  you  will  only  trust  yourself  to  my  guidance 
and  accept  my  teachings."  "  Why  !  "  she  promptly  answered,  "  of 
course  1  shall  do  so."  After  this  I  held  the  case  easily  in  hand. 
Right  heartily  did  she  hold  to  the  faith  so  cheerfully  professed.  Her 
vivacity  and  kind-heartedness  made  her  a  favorite  member  of  our 
family.  In  due  time,  after  she  had  left  us  as  recovered,  the  evidence 
of  her  permanent  restoration  to  health  and  to  new  purposes  of  life 
coming  to  us  through  the  echoes  of  marriage  bells,  was  accepted  as 
the  natural  sequence  of  that  morning  on  the  lawfi. 

I  shall  ever  remain  grateful  to  those  liberal  friends  on  record  in  the 
Report  of  the  Retreat  for  1S61,  who  gave  to  my  personal  solicitation 
the  ample  means  of  developing  the  natural  beauties  of  the  lawn,  the 
erection  of  the  museum,  the  Ives  amusement  hall,  with  many  orna- 
mentations which  have  since  been  found  to  be  such  efficient  thera- 
peutic remedies. 

Medicine  is  justly  divided  into  "  Prophylactic,  or  the  art  of  pre- 
serving health,"  and  "  Therapeutic,  or  the  art  of  restoring  it." 
Moral  Therapeutics  have  a  wide  range  ;  they  are  so  effectual  in  al- 
laying the  undue  excitability  of  the  disordered  mind,  and  in  diverting 
the  current  of  morbid  thought  back  into  the  natural  channels  of 
health. 

After  the  correction  of  those  physical  disorders  (so  generally  ac- 


20  THE   CURABILITY  OF  INSANITY. 

room  in  which  she  has  left  her  infant  child."  Bearing 
this  in  mind,  when  Mr.  Vaiix,  the  architect,  came  up  from 
New  York  to  examine  the  Retreat  as  to  its  reconstruc- 
tion, he  asked  me,  "  What  would  you  have  me  do  with 
this  old  building  ?  "  "  Reconstruct  the  '  Lunatic  Hospi- 
tal '  thoroughly,  and  develop  the  *  Home  '  for  the  nervous 
and  insane,"  was  my  answer.  The  result  was  a  success. 
In  one  of  my  earlier  reports  of  the  Retreat  I  stated 
that  of  one  hundred  and  eighty-seven  female  patients 
last  admitted,  thirty-four  per  cent,  were  wives  of  farmers 

cepted  as  "the  punctum  saliens,"  or  starting-point,  of  insanity),  I 
have  often  turned  successfully  to  this  department  of  Therapeutics  for 
that  "  Medicamentum  gratia  probatum  "  of  quaint  old  Paracelsus, 
the  "  remedy  approved  by  grace,"  for  restoring  the  sufferer  from  in- 
sanity to  a  right  mind. 

The  whole  forenoon  I  gave  this  young  lady  was  not  wasted.  I 
know  not  how  it  could  have  been  more  profitably,  humanely,  or  sci- 
entifically employed,  I  met  her  afterwards  more  or  less  frequently 
every  day,  keeping  quiet  but  careful  watch  over  her  progress. 

In  my  regular  morning  visits  to  the  various  departments  of  the 
House,  it  was  my  custom  to  have  itsimmates,  who  were  well  enough 
to  leave  their  rooms,  meet  me  in  the  parlor  attached  to  their  respec- 
tive halls.  Of  course  private  and  confidential  interviews  were  fre- 
quently required.  These  every-day  family-like  gatherings  proved 
far  more  than  formal  visits  to  each  room.  Such  informal  meetings, 
like  many  of  my  old-time  visits  in  general  practice,  were  so  homelike 
and  natural  that  their  influence  readily  drew  out  those  genial  and 
social  elements  of  the  heart  which,  in  the  most  extreme  developments 
of  insanity,  I  have  rarely,  if  ever,  found  beyond  our  reach.  For  here 
was  possible  "  that  intangible  permeation  of  a  household  not  too 
large  for  the  personality  at  the  head  of  it,"  The  conversations  were 
easy  and  natural,  often  bringing  out  the  mental  peculiarities  of  one 
and  another  ;  these  in  turn  leading  to  timely  criticisms,  and  then  to 
frank  and  general  discussions. 

The  best  results  depended  upon  the  discreet  association  of  varied 
elements.  Judicious  antagonisms  worked  better  than  similarities  ; 
the  excited  and  melancholic  amended  each  other,  while  the  appeal 
to  the  judgment  of  the  majority,  confirming  the  best  decision,  bene- 
fited both,  I  have  again  and  again  traced  the  final  results  of  suc- 
cessful treatment  to  such  persuasive  agencies,  by  which  doubts  were 


THE    CURABILITY  OF  INSANITY.  21 

and  mechanics — an  undue  proportion  of  these  classes  in 
the  State.  Many  were  young  women,  leaving  nursing 
children  at  home.  In  these  cases  it  had  naturally  fol- 
lowed from  the  sequences  of  child-bearing  and  child- 
nursing  ;  the  too  frequent  entire  absence  of  all  or  of  only 
the  brief  week's  service  of  the  "monthly  nurse";  the 
accumulation  of  household  duties  and  drudgeries  ;  nar- 
row and  near-sighted  economies,  and  absence  of  needed 
relief  of  change  and  recreation  ;  that  the  exhausted  wife 
lost,   in  due  time  and  course,  her  appetitite,  sleep,  and 

resolved,  darkness  lightened,  excitemer^t  subdued,  and  the  better 
mind  restored.  Pleasant  as  were  my  visits  to  such  associations,  I 
often  found  that  I  could  much  more  readily  decide  upon  the  best 
remedy  for  the  excited  maniac,  than  meet  to  their  satisfaction  or  my 
own  the  sharp  questions  presented  by  their  ready  wit. 

The  personal  influence  of  the  superintendent  is  naturally  trans- 
mitted to  the  assistant  physicians,  and,  by  their  concurrence,  to  all 
other  employes.  The  best  results  in  such  a  singularly  complicated 
household  can  only  be  obtained  when  its  various  officials  act  in  unity. 
Emerson  says:  "The  institution  is  the  shadow  of  the  man."  He 
must  be  such  a  one  that  the  shadow,  to  be  protective,  must  not  be 
too  thin  ! 

They  are  greatly  in  error  who  think  that  an  attack  of  insanity 
necessarily  eclipses  all  the  faculties  of  the  mind.  This  extremity  of 
disorder  is  rarely  seen.  Frequently  the.  one  delusion  (sometimes  the 
many)  are  kept  out  of  sight  so  ingeniously  as  to  elude  the  unskilful 
observer.  The  history  of  legal  investigations,  and  the  experience  of 
experts  in  insanity,  are  full  of  such  curious  instances,  and  not  the 
least  are  the  illustrations  of  the  ease  with  which  judge  and  jury  are 
sometimes  misled. 

I  record  one  of  many  cases  illustrating  that  mania  in  the  highest 
state  of  excitement  is  rarely  if  ever  lost  to  the  power  of  partial  self- 
control.  A  lady  once  under  my  care,  a  person  of  superior  intelligence 
and  mental  ability,  belonging  to  the  highest  circle  of  society,  became 
so  furiously  insane  that  she  was  destructive  and  dangerous  to  ap- 
proach, and  obliged  to  be  placed  in  a  room  without  movable  furni- 
ture. A  member  of  my  family  in  the  habit  of  making  frequent  visits 
to  her,  came  to  the  ward  to  see  her.  The  attendant  said  :  "  It  is 
impossible  for  you  to  go  to  her  room  this  morning  ;  it  is  dangerous." 
(The  lady  had  a  beautiful  bright  scarlet  shawl  around  her.)     "She 


22  THE   CURABILITY  OF  INSANITY. 

general  strength,  and  consequently  her  self-control,  and 
was  compelled  to  seek  the  recovery  of  all  in  the  Retreat. 
The  very  large  majority  of  these  cases  were  returned  to 
their  families  in  good  physical  and  mental  health  ;  the 
avoidable  causes  of  their  insanity  frankly  and  plainly  ex- 
plained to  them  and  to  their  friends,  with  instructions 
for  their  future  avoidance.  While  remedying  the  marked 
physical  disorders  and  debilities  which,  almost  without 
exception,  were  found  to  exist,  I  patiently  sought  to  gain 
the  confidence  of  each  one  by  the  persistent  use  of  indi- 
vidualized moral  as  well  as  remedial  treatment,  gradu- 
ally winning  their  sincere  trust  by  sympathy  with  their 
condition,  seeking  to  relieve  it  by  pleasant  and  varied 
occupation,  recreation,  and  amusement,  all  evidently  for 
the  one  result  of  promoting  their  restoration  to  health 
and  home  duties.^      From  this  confidence  there  naturally 


will  tear  your  shawl  to  atoms."  "  Well,"  she  said,  "  I  will  risk  it." 
Slfe  opened  the  door  and  met  the  patient  very  cordially,  who  at  once 
exclaimed,  "  Oh  !  what  a  lovely  shawl  !  "  She  caught  it  off,  and 
wrapping  it  around  herself,  sat  down  on  the  floor  with  her  visitor, 
and  had  a  long,  pleasant,  and  amusing  conversation.  The  visitor 
was  most  reluctantly  parted  with  ;  the  shawl  replaced  kindly  and 
carefully  by  the  patient.  After  her  recovery  the  lady  often  referred 
to  this  visit.      "  That  shawl  was  so  attractive,"  she  said. 

September,  184-. 
'  It  is  with  much  pleasure  that  I  take  my  pen  to  address  you  in 
respect  to  my  dear  wife.  She  stood  the  journey  remarkably  well, 
and  glad  indeed  was  she  once  more  to  hail  her  home  and  friends,  es- 
pecially her  little  danghter.  My  wife  appears  as  well  as  she  ever 
did  ;  she  has  a  good  appetite,  sleeps  well,  and  gains  flesh  every  day. 
Were  it  not  for  the  deep  trouble  and  anxiety  through  which  we  have 
passed,  we  should  not,  from  any  thing  on  her  part,  know  any  thing  of 
the  painful  affliction  through  which  she  has  passed.  We  are  all  now 
gathered  in  our  little  circle,  and  wliile  I  write  she  is  singing  like  a 
lark.  Happy  are  we,  indeed,  to  have  once  more  so  dear  a  one  to 
make  her  home  happy,  and  to  banish  the  desolation  and  loneliness 


THE   CURABILITY  OF  INSANITY.  23 

came  out  to  me  the  simply  told  stories  of  home — cause 
and  effect — stories  that  were  of  lives  more  patient,  unsel- 
fish, devoted,  and  oftentimes  tragic  than  any  novelist,  but 
one,^  has  ever  portrayed.  I  could  fill  page  after  page 
with  these  pathetic  illustrations  of  the  causes  of  insanity. 
I  often  found  that  the  instructions  given  to  these  patients, 
when  discharged,  and  to  their  friends,  prevented  the  re- 
currence of  their  insanity.  The  experience  of  both 
parties,  together  with  the  earnestness  with  which  they 
urged  others  similarly  afflicted  to  trust  themselves  to  its 
curative  influences,  with  the  frequent  tokens  of  their 
grateful  remembrance  of  benefits  conferred,  did  much  to 
dispel  the  too  common,  yet  causeless,  dread  of  the  Re- 
treat.    See  Appendix  (2). 

If  circumstances,  in  despite  of  experience  and  instruc- 
tion, compelled  them  to  be  again  exposed  to  the  same 
malignant  influences,  would  the  consequent  relapse  and 
re-admission  to  the  Retreat  invalidate  the  first  record  of 
"  Discharged  Recovered  "  P'"* 

that  rested  like  an  incubus  on  all  our  spirits  in  her  absence.  Much 
cause  have  we  to  be  thankful  to  the  God  of  all  our  mercies  for  the 
restoration  to  health  of  one  of  the  best  of  wives,  the  kindliest  and 
loveliest  of  mothers,  the  choicest  and  most  valued  of  friends.  Nor 
shall  we  soon  cease  to  remember  you,  and  the  rest  of  those  kind 
friends  who  have  been  instrumental,  through  the  mercies  of  Israel's 
King,  in  bringing  about  so  important  and  desirable  a  change.  May 
Heaven  shine  propitiously  on  your  arduous  labors,  and  crown  your 
efforts  in  behalf  of  suffering  humanity  with  success.  We  have  all 
been  at  my  father's  to  spend  the  day,  and  it  was  a  real  old-fashioned 
gathering  I  can  assure  you.  There  was  no  sighing,  and  anxious, 
painful  longing  for  the  dearest  of  our  flock. 

'  Rose  Terry  Cooke, 

'■^  More  than  all  other  physical  diseases,  insanity  requires  a  pro- 
tracted period  of  carefully  guarded  convalescence.  The  thorough 
restoration  of  the  fractured  limb  needs  the  curative  help  of  the  splin- 
ter or  the  crutch.     The   successful  physician  keeps  a  sharp  watch 


24  THE   CURABILITY  OF  INSANITY. 

A  healthy  young  fisherman,  by  needless  and  repeated 
exposures  in  the  Cove,  inducing  an  attack  of  acute  rheu- 
matism, "  hereditary  "  in  his  family,  is  admitted  to  the 
Hartford  Hospital.  He  is  successfully  treated,  and  in 
due  time  discharged  recovered.  If,  in  two  or  three  years 
afterwards,  disregarding  experience  and  professional  ad- 
vice, he  repeats  the  exposures,  induces  a  return  of  rheu- 

over  his  convalescing  cases  of  typhus,  pneumonia,  and  diphtheria. 
The  military  commander  guards  sharply  against  the  possible  midnight 
attack  of  his  apparently  defeated  enemy.  The  prolonged  residence 
at  the  Retreat  has  often  proved  its  practical  wisdom  by  the  results 
of  confirmed  convalescence.      I  recall  one  of  many  illustrations. 

A  farmer,  fairly  well  to  do,  in  middle  life,  of  a  nervous  tempera- 
ment, hardly  up  to  the  standard  of  general  health,  was  brought  to 
the  Retreat  in  a  state  of  high  nervous  excitement.  The  death  of  his 
father  had  left  a  considerable  property  to  be  divided  between  himself 
and  other  heirs.  An  acceptable  division  had  been  agreed  upon,  ex- 
cepting the  right  to  an  outlying  piece  of  land,  on  which  was  a  valua- 
ble bam.  The  quarrel  about  this  upset  the  reason  of  this  poor  man, 
and  brought  him  to  the  Retreat.  In  reasonable  time  his  debilitated 
system  yielded  to  treatment,  the  effect  of  unwise  discussions  and 
needless  excitement  giving  way  to  quiet,  genial  influences  and  pleas- 
ant surroundings  ;  all  which,  with  the  aid  of  good  digestion  and  suf- 
ficient sleep,  led  him  to  accept  the  evidences  of  his  mistake  regarding 
the  disputed  property.  This  had  been  fully  explained  to  me,  for  my 
possibly  timely  application.  In  this  state  of  early  convalescence,  his 
brother  came  to  see  him,  finding  him  out-of-doors,  quite  at  liberty, 
cheerful  and  reasonable,  and  apparently  "  as  well  as  ever."  The 
brother  insisted  upon  taking  him  home,  where  he  said  he  was  greatly 
needed.  My  advice  was  overlooked,  as  my  apprehension  was 
deemed  unfounded.  The  result  confirmed  my  judgment.  The  man 
was  brought  liack  the  next  day  in  a  highly  excited  condition.  The 
brother  reported  that  he  seemed  as  well  as  ever  while  they  were  re- 
turning home,  till,  unluckily,  to  shorten  distance,  they  took  a  cross- 
road that  brought  them  suddenly  up  to  the  old  barn,  "  when  he 
jumped  right  up  in  the  wagon,  as  crazy  as  ever."  He  seemed  glad 
to  be  back  at  the  Retreat,  remained  willingly,  and  finally  recovered. 
On  his  next  departure,  bidding  him  a  hopeful  good-by,  I  jocosely 
told  him  not  to  take  that  shorter  road  home.  "  Never  you  fear, 
doctor,"  he  replied,  "it  will  be  a  long  time  before  I  go  near  that 
confounded  old  Vjarn  again."  As  he  was  never  re-admitted  I  am 
sure  he  found  that  the  longer  way  round  proved  the  safer  way  home  ! 


THE    CURABILITY  OF  INSANITY.  25 

matism,  is  again  admitted,  and  again  discharged  recov- 
ered, does  the  last  record  annul  the  primary  one  of 
recovery  ?  and  if  not,  why  should  not  the  same  law  of  re- 
ported results,  valid  at  the  Hospital,  obtain  across  the 
street,  at  the  Retreat  for  the  insane  ? 

An  eminent  writer  (Huxley)  points  out  that — 

In  the  present  rapid  growth  of  the  minutest  branches  of  most  of 
the  sciences,  and  the  consequent  tendency  to  narrowness  which  this 
diminishing  scale  of  research  seems  likely  to  invoke,  all  men  of  sci- 
ence should  be  primarily  so  educated  as  to  secure  breadth  of  scien- 
tific education  without  superficiality  of  knowledge,  as  the  best  secur- 
ity against  the  natural  danger  of  drifting  into  narrow  specialties. 

In  view  of  the  largely  increasing  varieties  of  disorders 
from  which  insanity  may  originate,  and  of  the  many  new 
remedies,  in  addition  to  the  better  knowledge  of  the  old, 
which  come  to  the  aid  of  medicine  in  the  progressing  art 
of  preserving  and  restoring  health — the  broader  reach- 
ings  of  prophylactic  and  therapeutic  agencies — the  prac- 
tical alienist  should  possess  not  only  a  readily  available 
knowledge  of  all  this,  but  keep  a  careful  watch  over  the 
possibilities  of  the  future.  The  comparison  of  the  Dis- 
pensary (or  "  Bigelow's  Sequel  ")  at  the  date  of  my  grad- 
uation, in  1828,  with  that  of  to-day,  naturally  suggests  the 
possible  future  of  some  of  the  one  hundred  thousand 
weeds  "  whose  virtues,"  Emerson  says,  "  are  yet  to  be  dis- 
covered." Certainly  most,  if  not  all,  the  original  thirteen 
members  of  the  Association  had  a  large  experience  in 
general  practice  before  assuming  special  charge  of  the 
insane. 

Dr.  Parkes  says  :  ''  Hygiene  aims  at  rendering  growth 
more  perfect,  decay  less  rapid,  life  more  vigorous,  deatli 


26  THE   CURABILITY  OF  INSANITY. 

more  remote."  The  acceptance  of  this  art  or  science  of 
preserving  health  has  within  the  past  thirty  years  added 
nearly  four  years  to  the  average  life  of  the  men  and 
women  in  England.  The  humane  and  scientific  re- 
searches of  Dr.  Bowditch,  of  Boston,  have  largely  limited 
the  ravages  of  consumption  in  New  England.  The  es- 
tablishment of  thirty-one  State  Boards  of  health,  in  the 
United  States,  since  that  of  Masschusetts,  in  1869,  and 
the  increasing  acceptance  of  the  vital  necessities  of  sani- 
tary reform,  all  lead  us  to  hope  that  erelong  consump- 
tion, malaria,  and  insanity,  with  many  other  formidable 
enemies  of  health  and  life,  may  be  met  by  some  new  an- 
tagonistic power. 

In  measuring  our  means  of  arresting  insanity  we  must 
accept  the  science  of  prevention  as  a  higher  power  than 
the  science  of  remedy,  a  power  to  be  looked  for  outside 
the  wards  of  a  hospital.  ''  True  medicine,"  says  Dr. 
Richardson,  "  now  stands  boldly  forth  to  declare  the 
higher  philosopliy — the  prevention  of  disease."  "Our 
art,"  says  Dr.  Bowditch,  "looks  still  higher,  to  the  pre- 
vention as  well  as  the  cure  of  disease."  Prevention 
justly  takes  precedence.  Very  many  of  the  ordinary 
causes  of  insanity  may  be  easily  avoided,  and,  if  need- 
lessly induced,  may  be  readily  overcome.  They  are  the 
natural  outgrowth  of  heedless  or  ignorant  violation  of 
well-established  laws  of  hygiene — laws  that  should  be  in- 
telligently taught  in  every  common  school  in  the  land. 
There  are  other  causes  of  far  graver  import  than  they  at 
first  suggest,  where  prevention  demands  that  the  earliest 
symptoms  should  be  promi)tly  recognized  and  efficiently 
treated.     Dr.  Tuke  says  : 


THE    CURABILITY  OF  INSANITY.  2/ 

The  prevention  of  disease  is  the  first  and  most  earnest  intention  of 
medical  science  in  all  its  departments.  The  prevention  of  mental 
disease  is  clearly  within  the  scope  of  the  physician's  highest  aim. 

He  further  says  : 

No  medical  forethought  can  prevent  the  occurrence  of  insanity 
from  accidental  causes,  but  a  vast  proportion  of  the  insane  become  so 
in  consequence  of  physical  conditions  of  life  and  modes  of  living, 
which  lead  to  the  result  as  certainly  as  unsanitary  conditions  of  physi- 
cal life  lead  to  typhoid  fever  or  tuberculosis.  It  is  in  such  cases  that 
a  prophylaxis  can  sometimes  be  established.  Moral  treatment  is  the 
true  prophylaxis.  If  the  most  favorable  instances  of  these  ailing 
minds  are  brought  under  the  influence  of  strong  and  healthy  minds, 
the  fearful  heritage  may  oftentimes  be  avoided. 

Dr.  Conolly  dwells  at  length  upon  the  effects  he  has 
witnessed  from  the  "individualized  treatment  " — the  in- 
fluence of  a  sane,  addressed  to  an  insane  mind." 

'  Universally  in  zymotic  disease,  and  generally  in  all  others,  the 
practitioner  finds  a  law  of  rise,  progress,  and  limitation.  This  ac- 
cepted, it  remains  to  watch  over  the  course  of  the  disease,  antagoniz- 
ing the  deviations  and  the  often  perilous  complications.  No  such 
law  is  found  in  insanity  ;  its  origin  is  more  obscure,  its  range  is 
wider,  its  development  is  more  varied,  unexpected,  and  seemingly 
unreasonable.  Sometimes  in  its  formative  stage,  a  specific  delusion 
originating  in  a  doubt  or  question  develops  gradually,  growing  witli 
the  growth,  and  strengthening  with  the  strength  of  the  disorder, 
until  it  becomes  a  fixed  habit  ;  the  mind  running  in  a  rut  influences 
every  motive  and  thought  of  the  daily  life.  This  will  sometimes  re- 
main painfully  dominant  after  every  other  symptom  has  yielded. 
Few  conditions  of  a  patient  under  treatment  are  more  painfully  em- 
barrassing ;  the  apprehension  naturally  arises  that  some  one  portion 
of  the  brain,  and  a  very  limited  one  it  may  be,  is  seriously,  perhaps 
hopelessly  disordered.  Mere  the  natural  hopefulness  of  trained  in- 
dividuality leads  to  persevering  eff^ort,  vm  the  hope  that  some  sharp, 
unexpected  impulse  may  shake  o[{  this  incubus,  which  like  Sindbad's 
"  Old  Man  of  the  Sea"  threatens  to  hold  on  to  the  end. 

Some  years  ago  a  gentleman  about  thirty  years  of  age  was  brought 
to  the  Retreat  in  a  truly  deplorable  condition.     He  was  an  officer  in 


28  THE    CURABILITY  OF  INSANITY. 

Ill  the  application  of  moral  treatment  it  is  of  vital  im- 
portance so  carefully  to  scrutinize  the  environment  of 
each  patient  as  to  avoid  as  far  as  possible  all  depressing 
or  exciting  influences.  All  accept  the  axiom  that  cheer- 
fulness and  sympathy  in  any  sick-room  promote  the  best 
working  of  remedies  ;  in  the  wards  of  a  lunatic  hospital, 
remedies  avail  little  without  their  cooperation.  I  have 
found  few  things  more  depressing  and  harmful  to  the  re- 
cent and  hopefully  curable  cases  of  insanity,  than  even 
the  sight,  and,  much  more,  the  association  with  the  de- 
mented and  hopeless.  To  such  cases  (excluding  the  few 
the  severity  of  whose  disorder  prevents  any  realization 
of  their  condition),  finding  themselves  in  the  bewilder- 
ment of  such  surroundings,  their  natural  conclusion  is  : 
"  I  am  one  of  a  hopeless  crowd  ;  what  better  chance  can 

active  service  under  the  national  government.  His  duties,  invoh'- 
ing  large  responsibilities,  under  harassing  circumstances,  in  a  tropi- 
cal climate,  were  prolonged  without  change  until  he  broke  down 
both  in  body  and  mind,  A  rigid  sense  of  duty  had  led  him  without 
complaint  or  request  for  relief  to  this  possibly  fatal  overwork.  His 
case  presented  on  admission  an  unusual  combination  of  discouraging 
symptoms.  Happily  his  one  overruling  delusion  disposed  him  cheer- 
fully to  accept  his  position  with  us.  After  some  months  of  careful 
watching,  patient  care,  and  that  due  medication  which  the  condition 
of  nearly  every  physical  organ  demanded,  his  general  health  seemed 
fairly  restored.  He  had  a  good  digestion,  and  plenty  of  that  "  best 
food  of  the  brain,"  sleep.  Notwithstanding  all  this  one  great  anxi- 
ety remained  to  me  in  his  delusion,  the  vividness  and  tenacity  of 
which  I  have  rarely,  if  ever,  seen  equalled  under  similar  conditions 
of  general  health.  No  belief  whatever  was  more  firmly  held  by  him 
than  that  for  a  neglect  of  official  duty  his  life  was  forfeited  ;  the  De- 
partment having  resolved  to  order  his  execution  in  a  signal  and  im- 
pressive manner.  He  confessed  the  offence  was  a  trifling  matter, — 
in  truth  the  oversight  of  a  Htbordinate.  But  its  frequent  repetition, 
in  contem);t  of  repeatefl  orders,  had  compelled  the  Secretary  to  make 
an  example.  All  reasoning  with  my  jialient  seemed  worse  than  use- 
less ;  the  only  comfort  J  gave  him  was  the  assertion  that  no  g(wern- 
ment,  State  or  General,  could  take  him  from  the  Retreat  against  my 


THE    CURABILITY  OF  INSANITY.  29 

I  have  of  recovery  ?  "  The  number  of  patients  in  some 
of  our  State  hospitals  exceeds  the  population  of  more 
than  each  one  of  forty  of  the  towns  of  the  State  of  Con- 
necticut. In  several  the  recent  case  on  admission  be- 
comes the  legally  committed  citizen  of  a  community 
whose  annual  official  report  records  more  discharges  by 
death  than  by  recovery  from  insanity.  Classified,  how- 
ever carefully,  as  the  multitude  may  be,  the  different  in- 
dividuals must  come  frequently  in  contact  in  the  chapel, 
and  in  the  means  of  their  recreation  and  amusement. 
With  such  immediate  surroundings  the  recent  case  can 
hardly  look  from  his  window  or  step  out  of  his  door  with- 
out seeing  or  hearing  some  hopeless  victim  of  a  disease 
from  which  he  has  fainting  hopes  of  his  own  recovery. 
Reason  as  you  may  with  him,  for  the  present  time,  at 


record  of  "  not  recovered."  Afterwards,  avoiding  the  discussion, 
I  continued  every  effort  to  strengthen  his  general  health,  and  to 
amuse  and  occupy  his  mind,  awaiting  my  opportunity,  and  this  in 
time  came.  One  morning,  when  he  seemed  more  bright  and  genial 
than  usual,  I  referred  jocosely  to  our  old  difference  of  opinion,  and 
confessing  that  discussions  were  useless  with  one  who  clung  to  a  de- 
lusion with  the  obstinacy  of  Tam  O'Shanter's  wife,  who  "hugged 
her  wrath  to  keep  it  warm,"  T  told  him  that  I  was  sure  that  in  good 
time  his  large  stock  of  common-sense  would  come  to  the  front,  and 
added  most  seriously  and  earnestly  :  "  If  I  were  now  to  give  you  the 
endorsed  testimony  of  your  Department  of  your  deserved  high  stand- 
ing as  an  officer,  and  that  your  official  record  was  without  fault  or  re- 
proach, I  really  fear  you  would  reject  it."  "Oh!  no  indeed,  I 
would  not  !  if  you  would  only  show  me  that,"  he  replied.  Drawing 
from  my  pocket  the  formal  official  document,  I  answered  :  "  I  re- 
joice that  I  can  do  so.  Here,  in  reply  to  my  letter  of  inquiry,  is  the 
prompt  and  cordial  answer  of  the  Department,  a  flattering  certifica- 
tion of  your  high  position  in  the  service."  He  received  it  with 
much  emotion.  The  effect  was  electrical.  He  seemed  to  awake,  as 
it  were,  from  an  oppressive  dream.  When  he  came  down  next 
morning  to  make  arrangements  for  his  return  home,  he  was  a  very 
happy  and  sane  man. 


30  THE    CURABILITY   OF  INSANITY. 

least,  the  "  twirling  thumbs  "  will  beat  down  your  sani- 
tary arguments. 

We  believe  that  absolute  segregation  is  possible,  and  is 
consistent  with  a  large  economy  in  construction  and  in 
current  expenses.  The  telegraph,  the  telephone,  and  the 
tramway  may  bring  the  annex  of  the  main  hospital  suffi- 
ciently near,  so  that  out  of  sight  and  out  of  hearing,  at  the 
distance,  more  or  less,  of  a  mile,  these  apparently  sepa- 
rate institutions  are  within  easy  reach  of  the  sharp  super- 
vision of  the  chief  superintendent.  Again,  the  query 
may  be  raised  whether,  in  the  continued  growth  of  very 
large  institutions,  there  may  not  be  developed  in  the 
future  a  school  of  hospital  specialists,  simply  executive 
officers,  skilled  in  economic  management  and  training, 
instead  of  broad,  earnestly  sympathetic,  and  versatile 
physicians  of  large  experience,  through  study  of  individ- 
ual cases. 

Our  position  is  amply  confirmed  by  authorities  who 
have  the  right  to  speak  and  to  be  heard.  At  the  meeting 
of  the  International  Medical  Congress  in  Philadelphia, 
in  1876,  Dr.  Ray  said  : 

As  the  result  of  my  own  observation  and  experience  I  am  con- 
vinced that  four  hospitals  of  three  hundred  patients  each  can  be  both 
built  and  maintained  at  a  less  cost  than  one  of  twelve  hundred  pa- 
tients, equal  provision  being  made  in  both  cases  for  the  kind  of  care 
to  which  the  insane,  even  in  the  lowest  grades  of  the  disease,  are 
entitled. 

Again  he  says  : 

I  doubt  whether  it  is  possible  to  have  in  these  mammoth  establish- 
ments certain  qualities  of  administration  indispensable  to  their  high- 
est purposes.     The  animating  spirit,  the  close,  thorough  supervision, 


THE    CURABILITY   OF  INSANITY.  3 1 

inspiring,  guiding,  correcting  every  movement,  and  essential  to  our 
highest  ideas  of  hospital  management,  will  be  but  feebly  maintained 
under  such  conditions.  The  patient  is  but  an  atom  in  the  great  mass 
around  him,  losing  the  attributes  of  humanity,  sane  and  insane,  in 
the  technical  character  of  patients. 

At  the  same  meeting  Dr.  Kirkbride  said  : 

It  is  fully  shown  by  reliable  statistics,  as  I  believe,  that  the  people 
of  the  State  will  derive  more  benefit  from  several  small  hospitals  in 
different  parts  of  the  State  than  from  one  large  one  at  a  central  point. 
And  I  think  it  will  also  be  found  that  the  former  can  be  provided 
with  quite  as  small  an  expenditure  of  money,  and  could  be  carried  on 
at  no  greater  cost  per  patient.  .  .  ,  There  is  one  advantage  in 
these  smaller  hospitals  I  cannot  avoid  referring  to,  and  that  is  the 
personal  intercourse  which  a  superintendent  is  able  to  give  to  his  pa- 
tients when  their  number  is  not  so  great  as  to  prevent  his  paying 
daily,  or  very  nearly  daily,  visits  to  eacli.  I  believe  this  to  be  one  of 
the  most  important  of  all  his  duties,  and  one  which,  certainly,  if  he  is 
rightly  constituted  for  his  position,  no  one  can  do  for  him. 

Dr.  E.  C.  Seguin,  of  New  York,  in  a  letter  to  a  mem- 
ber of  our  Legislature,  1880,  says  : 

The  vast  majority  of  the  insane  are  afflicted  with  chronic  and  in- 
curable disease.  They  need  only  humane  treatment,  the  largest  pos- 
sible amount  of  personal  liberty,  plenty  of  occupation,  some  amuse- 
ment, the  plainest  quarters,  and  the  simplest  diet  consistent  with  the 
demands  of  modern  hygiene.  They  do  not  require  the  attention  of  as 
high  a  grade  of  medical  talent  or  as  numerous  and  skilled  attendants 
as  do  acute  cases.  They  can,  I  believe,  be  well  taken  care  of  at  a 
comparatively  small  cost.  It  seems  a  reckless  waste  of  money  to 
build  palatial  hospitals  to  be  filled  with  incurables.  .  .  .  The 
curable  insane  need  the  highest  medical  skill  which  a  large  salary  can 
attract ;  a  much  larger  number  proportionately  of  assistant  physicians 
selected  by  severe  examination  ;  many  real  nurses,  not  mere  attend- 
ants or  guardians.     They  require  the  best  food,  with  the  liberal  use 


32  THE   CURABILITY  OF  INSANITY. 

of  costly  medicine,   etc.     It  is    economical   and   humane   to   spend 
money  freely  in  order  to  facilitate  recovery. 

An  intimate  knowledge  of  the  condition  of  the  insane 
for  more  than  half  a  century  has  given  me  an  increasing 
sympathy  for  them  as  the  most  grievously  afflicted  of  the 
human  family.  Both  my  experience  and  observation 
since  the  meeting  of  the  Association  in  1844  have  con- 
vinced me  that  the  great  and  unexpected  changes  in  their 
numbers  and  relative  condition  demand  some  modifica- 
tion of  the  original  propositions.  That  which  gave  two 
hundred  as  the  preferable  maximum  of  patients  to  be 
treated  in  one  building,  may  again  be  as  wisely  accepted 
in  connection  with  a  new  classification.     See  Appendix 

(3). 

In  conclusion,  let  me  quote  from  Dr.  Ray,  one  known 
to  us  all,  and  best  esteemed  and  honored  by  those  who 
knew  him  best,  and  who,  in  his  description  of  the  "  Good 
Superintendent,"  has  given  us  a  most  happy  photograph 
of  his  own  hospital  life  : 

The  "  Good  Superintendent  "  constantly  striveth  to  learn  what  is 
passing  in  the  mind  of  his  patient,  by  conversation  and  inquiry  of 
those  who  see  him  in  his  unguarded  moments.  He  also  maketh  dili- 
gent inquiry  respecting  the  bodily  and  mental  traits  of  his  kindred, 
knowing  full  well  that  the  sufferer  is  generally  more  beholden  to 
them  than  to  himself,  for  the  evil  that  has  fallen  upon  him.  He  en- 
deavoreth  so  to  limit  the  number  committed  to  his  care  as  to  obtain  a 
personal  knowledge  of  every  wandering  spirit  in  his  keeping.  He 
boasteth  not  of  the  multitudes  borne  on  his  register,  but  rather,  if  he 
boasteth  at  all,  of  the  many  whose  experience  he  has  discovered, 
whose  needs  he  has  striven  to  supply,  whose  moods,  fancies,  and  im- 
pulses he  has  steadily  watched.  To  fix  his  hold  on  the  confidence 
and  good-will  of  his  patients  he  spareth  no  effort,  though  it  may  con- 


THE  CUkABlLITV  OF  INSAMtTV.  33 

sume  his  time  and  tax  his  patience  or  encroach  seemingly  on  the  dig- 
nity of  his  office.  A  formal  walk  through  the  wards  and  the  ordering 
of  a  few  drugs  compriseth  but  a  small  part  of  his  means  of  restoring 
the  troubled  mind.  To  prepare  for  this  work  and  to  make  other 
work  effectual,  he  carefully  studieth  the  mental  movements  of  his  pa- 
tients. He  never  grudgeth  the  moments  spent  in  quiet,  familiar  in- 
tercourse with  them,  for  thereby  he  gaineth  many  glimpses  of  their 
inner  life  that  may  help  him  in  their  treatment.  Among  them  are 
many  sensible  to  manifestations  of  interest  and  good-will,  and  the 
good  physician  esteemeth  it  one  of  the  felicities  of  his  lot  that  he  is 
able  to  witness  their  healing  influence.  He  maketh  himself  the  cen- 
tre of  their  system,  around  which  they  all  revolve,  being  held  in  their 
places  by  the  attraction  of  respect  and  confidence.  To  promote  the 
great  purpose  of  his  calling  he  availeth  himself  of  all  his  stores  of 
knowledge,  that  he  may  converse  with  his  patients  on  matters  most 
interesting  to  them,  and  thereby  establish  with  them  a  friendly  rela- 
tion. The  unwelcome  communication  he  ever  tempereth  with  soft 
and  pleasant  words,  thereby  verifying  in  himself  that  saying  respect- 
ing a  worthy  of  old,  that  he  made  a  flat  refusal  more  agreeable  than 
others  did  the  most  thorough  compliance. 

In  my  report  of  the  Retreat  for  i860,  I  remarked  that 
over  three  thousand  cases  of  insanity  have  now  come  un- 
der my  direct  care  and  observation.  In  a  large  propor- 
tion of  those  cases  whose  history  I  could  obtain,  I  have 
found  that  the  remote  and  predisposing  causes  of  insan- 
ity could  be  plainly  traced  to  the  malign  influences  of 
childhood. 

In  this  connection  I  quoted  the  following  from  Gen- 
eral Oliver's  report  to  the  Massachusetts  Board  of  Edu- 
cation : 

While  we  abundantly  provide  for  the  thorough  training  of  the 
mind,  we  almost  wholly  neglect  the  training  of  the  body,  and  the  ef- 
fect of  this  pressure  upon  the  intellect  without  corresponding  pres- 
sure of  the  body  is  that  the  latter  suffers,  and  by  degrees  the  feeble- 

/ 


34  THE   CURABILITY  OF  INSANITY. 

ness  which  is  generated  by  this  want  of  proper  physical  exercise  of 
the  body  extends  to  the  mind  ;  for  the  twain  are  in  incomprehensible 
mystery  of  connection,  and  each  is  participant  of  the  other's  strength 
or  weakness.  So  then  the  mind  becomes  less  vigorous  by  reason  of 
the  fading  vigor  of  the  body,  as  the  body  is  always  weakened  by  the 
fading  powers  of  the  mind,  and  each  gradually  participating  in  a  grad- 
ual antasionism  to  the  efforts  of  educators  and  the  efforts  of  self-edu- 
cation.  This  is  especially  true  of  our  girls.  Our  boys  indulge  more 
in  vigorous  and  active  exercises.  Athletic  sports  are  full  of  interest 
to  them,  and  into  them  they  go  with  a  rush  and  a  relish  and  a  hearti- 
ness of  fun  most  cheering  to  behold,  and  most  excellent  in  its  influ- 
ence upon  their  bodily  health.  But  of  how  little  physical  exercise  do 
our  girls  partake,  and  how  quick  are  we  to  check  any  propensity  to 
activity  in  play  and  to  any  romping  gambols  or  vigorous  recreation 
on  their  part.  ...  I  venture  to  say  that  not  more  than  one  girl 
in  ten  nowadays  enjoys  real  sound,  rugged  health,  and  surely  that  is 
a  very  unwelcome  statement  about  those  who  are  expected  hereafter 
to  be  helpmates  to  husbands  and  mothers  of  children. 

In  an  admirable  article  upon  Insanity  and  Hospitals 
for  the  Insane,  prepared  for  the  National  Almanac,  Dr. 
Earle  remarks  : 

That  it  is  not  the  regular  employments  of  mankind  which  are  the 
most  prolific  causes  of  insanity.  It  is  rather  those  habits,  customs, 
and  other  influences  which  minister  to  his  appetites,  stimulate  his 
passions,  and  most  powerfully  operate  upon  his  sentiments. 

Intemperance  of  all  kinds,  debauchery,  self-abuse,  all  high  popu- 
lar excitements  whatever  maybe  the  subject,  these  excite  and  exhaust 
the  nervous  energy  ;  and  grief,  anxiety,  troubles,  difficulties,  and  dis- 
appointments greatly  depress  it.  To  these  influences  then  we  may 
rightfully  look  as  among  the  most  powerfully  exciting  causes  of  the 
disorder  in  question. 

In  the  thirty-ninth  of  the  Retreat's  reports  it  will  be 
seen  that  of  nine  thousand  four  hnndred  and  seventy- 
three  cases,  as  given  by  Dr.  Earle,  being  the  total  of  all 


THE   CURABILITY  OF  INSANITY.  35 

cases  admitted  in  four  prominent  hospitals  wherein  the 
causes  of  insanity  were  given,  seven  thousand  five  hun- 
dred and  ninety-one,  or  four  fifths  of  the  whole,  were  the 
results  of  some  one  of  ten  causes,  all  of  which  were  such 
as  exhaust,  debilitate,  or  depress  the  vital  or  nervous  en- 
ergies. A  sensual  and  selfish,  or  idle  and  aimless  life, 
must  inevitably  act  as  a  predisposing  cause  to  the  devel- 
opment of  one  or  more  of  these  causes.  In  a  large  pro- 
portion of  the  cases  which  have  come  into  my  care 
insanity  might  have  been  prevented  by  the  use  of  well- 
known  measures,  or  natural  and  right  development  of 
body  and  mind,  wise  aims  in  life,  and  a  reasonable  exer- 
cise of  self-control.  The  power  of  the  will  to  control  the  '  ^ 
insane  impulse  is  great,  but  its  power  to  effect  this  result 
must  be  trained  and  be  made  conscious  of  its  supremacy. 
The  question,  therefore,  how  shall  I  escape  insanity  ?  is 
one  capable  of  a  more  direct  and  explicit  answer  than 
many  parents  and  educators  of  youth  seem  to  imagine.  ) 
See  Appendix  (4). 

It  follows,  as  a  necessary  consequence,  that  whatever 
makes  us  better  or  wiser,  gives  us  more  correct  views  of 
our  duties  to  God  and  our  neighbor,  and  at  the  same 
time  gives  us  more  courage,  strength,  and  willingness  to 
do  that  duty,  places  us  so  much  more  beyond  the  reach 
of  these  causes  of  insanity,  and  gives  us  also  the  greater 
ability  to  resist  successfully  the  attacks  of  this  disease 
when  induced  by  causes  beyond  our  control. 

Insanity,  as  a  strictly  physical  disease,  comes  emi- 
nently within  the  range  of  preventive  medicine.  When 
our  proposed  and  thorough  system  of  State  sanitary  regis- 
tration in  Connecticut  is  carried  out  (if  ever),  and  each 


36  THE   CURABILITY  OF  INSANITY. 

case  is  reported  in  its  earlier  stages,  we  may  hope  to  at- 
tain a  more  accurate  knowledge  of  the  predisposing  and 
exciting  causes  of  this  malady,  which  is  filling  our  luna- 
tic hospitals  faster  than  we  do  or  can  build  them.  We 
can  also  more  efficiently  apply  the  means  of  prevention 
and  remedy,  when  we  can  better  measure  its  various 
causes  :  erroneous  educational  and  social  influences,  neg- 
lect of  family  training  to  reverence  and  obedience,  sen- 
sational reading,  evil  habits  of  body  and  mind,  idle,  aim- 
less, or  sensual  life,  and  learn  more  exactly,  as  we  shall 
learn,  how  very  early  in  life  the  predisposing  causes  of 
insanity  are  implanted  in  the  child. 

During  the  present  century,  no  greater  progress  has 
been  made  in  any  department  of  philanthropy  and  sci- 
ence than  in  the  direction  of  the  better  care  and  treat- 
ment of  the  insane.  A  greater  work  remains  to  be  done, 
a  work  greater  than  cure  or  kindly  care — that  of  preven- 
tion ;  a  work  which,  in  order  to  be  of  the  highest  suc- 
cess, must  reach  back  often  to  the  early  life,  the  family, 
the  nursery,  and  the  school. 

The  question  before  us  to-day  is  not  only,  what  can 
the  State  do  for  the  chronic  insane  ?  but  the  wiser  and 
more  timely  question,  how  can  we  prevent  insanity  ? 

The  neglect  of  physical  training,  and  the  imperfect 
physical  development  which  follows  from  this  neglect, 
were  strikingly  evident  in  many  of  my  female  patients. 
The  various  causes  which  were  reported  to  me  as  the 
sources  of  disease,  and  which  are  classified  in  the  tables 
under  the  head  of  "  ill-health,"  "  undue  mental  effort," 
"  grief,"  "  domestic  unhappiness,"  etc.,  could  very  fre- 
quently be  traced,  in  their  primary  influences,  to  the  one 


r//^   CURABILITY  OF  INSANITY.  -i,"/ 

cause  of  a  want  of  physical  stamina.  We  press  the  train- 
ing of  the  mind,  by  all  possible  hours  of  study  in  and 
out  of  school,  and  by  the  added  stimulus  of  emulation, 
while  we  neglect  the  training  of  the  body,  in  disregard 
of  that  mysterious  but  absolute  law  of.  sympathy,  which 
compels  the  debility  of  the  latter  to  cripple  the  action  of 
the  former.  In  the  same  line,  is  the  prevention  of  ex- 
citement so  happily  illustrated  in  the  Northampton  Hos- 
pital by  Dr.  Earle,  where  the  busy  day  on  his  thoroughly 
cultivated  farm,  followed  by  a  quiet  night,  illustrates, 
happily,  the  sanitary  results  of  wisely  directed  occupa- 
tion. 

Life  has  been  compared  to  a  line — that  of  birth,  the 
point  of  origin,  that  of  death,  the  point  of  termination, 
the  length  of  the  line  between  being  an  uncertain  quan- 
tity under  a  supposed  secret  and  inexorable  law,  over 
which  we  were  ignorantly  believed  to  have  no  control. 
The  history  of  the  human  race  has  ever  testified  to  the 
incessant  craving  of  the  heart  that  "  our  days  may  be 
prolonged  in  the  land."  The  Science  of  Preventive 
Medicine  justifies  this  innate  desire  by  demonstrating 
that  it  possesses  the  power  to  give  a  longer  extension  and 
a  more  definite  and  certain  quantity  to  this  "line  of  life." 
We  are  told  that  the  days  of  our  years  are  threescore 
years  and  ten,  and  that  if  we  are  deprived  of  the  "  resi- 
due of  our  years,"  and  do  so  generally  fall  far  short  of 
that  attainment,  it  will  be  well  for  us  more  carefully  to 
regard  that  wonderfully  true  and  perfect  sanitary  code 
given  to  the  Jewish  nation,  and  recorded  for  our  instruc- 
tion and  guidance  in  the  Holy  Scriptures,  and  remember 
through  their  obedience  to  those  hygienic  laws  *'  He  in- 


3S  THE   CURABILITY  OF  INSANITY, 

creased  the  people  greatly,  and  made  them  stronger  than 
their  enemies,"  and  when  he  brought  them  forth  out  of 
the  land  of  Egypt,  "  there  was  not  one  feeble  person 
among  their  tribes."     Nor  one  insane  ! 

In  many  of  the  insane  the  power  of  observation  is  ac- 
tive and  the  understanding  has  a  considerable  range  of 
exercise,  while  the  affections  exist  as  warmly  and  the 
sensibility  is  as  acute  as  in  a  state  of  perfect  mental 
health.  The  utmost  care  therefore,  should  be  taken  to 
act  on  what  remains  of  intellect,  wisely  to  direct  the  im- 
paired faculties  of  the  understanding,  and  at  the  same 
time  to  cherish  and  govern  the  affections  by  all  the  re- 
sources of  compassionate  protection. 

To  suppose  that  the  inmates  of  a  lunatic  asylum  must 
necessarily  be  in  a  state  of  continual  unhappiness,  is  as 
erroneous  as  to  suppose  the  asylum  itself  a  place  only 
for  confinement  and  suffering.  There  is  a  wonderful 
diversity  in  the  manifestations  of  this  disease,  each  case 
having  its  peculiar  character  :  the  melancholic,  who  sup- 
poses God  has  forsaken  him  for  time  and  eternity ; 
the  excitable,  defying  all  law  but  his  own  sovereign  will ; 
and  those  who,  less  gravely  affected,  are  yet  unfitted  for 
the  duties  of  life,  and  are  waiting,  with  more  or  less  of 
patience  and  resignation,  the  time  of  their  recovery." 

'  The  history  of  one  of  my  patients  in  the  Retreat  made  such  an  im- 
pression that  I  cannot  refrain  from  describing  it  in  some  detail.  She 
was  a  married  lady,  under  middle  age,  well  developed  physically, 
with  a  genial  and  easily  impressible  temperament,  which,  with  her 
happy  manner,  made  her  a  universal  favorite.  On  admission  to  the 
Retreat  she  left  an  intelligent  and  devoted  husband,  several  charm- 
ing children,  and  ample  means  in  a  pleasant  home.  The  history  of 
the  case,  as  given  to  me,  showed  that  the  gradually  widening  scope  of 
maternal  duties  and  household  cares  had  unconsciously  led  her  to  a 
devoted  but  really  reckless  draft  upon  her  physical  energies,  which 


THE  CURABILITY  OF  INSANITY.  39 

Now,  as  amusement  and  recreation  are  essential  to  the 
preservation  of  the  health  of  body  and  mind,  and  as  their 
genial  influence  is  fully  appreciated  by  us  during  the 
convalescence  from  an  ordinary  illness,  how  much  more 
sensitive  to  their  effect  must  be  those  who  are  suffering 
under  this  graver  disorder. 

in  due  course  brought  on  a  disorder  of  the  widest  range  of  the  diges- 
tive apparatus,  and  consequently  and  most  naturally  of  other  equally 
vital  organs  sympathizing  with  it.  The  derangement  of  the  nervous 
system  was  the  common  and  natural  sequence  of  loss  of  appetite, 
loss  of  sleep,  and  loss  of  both  physical  and  nervous  power. 

I  found  her  emaciated,  enfeebled,  and  dejected  ;  the  whole  system 
"fagged"  (I  can  find  no  better  word  for  its  best  description). 
The  case  was  one  of  functional  disorder,  primarily  induced  by  readily 
preventible  causes  ;  easily  remedied  in  its  early  stages  by  simple 
means.  But  the  system  had  literally  drifted  into  a  condition  where 
there  was,  at  first  sight,  some  apparent  reason  to  fear  disease  of  the 
brain,  or  change  of  cerebral  structure. 

A  close  scrutiny  into  the  case  revealed  its  simple  character.  The 
suicidal  tendency  which  at  first  I  had  reason  to  fear  (but  which  was 
never  discussed  between  us)  soon  ceased  to  worry  me.  The  general 
treatment  required  for  its  ultimate  and  entire  succcess  some  months 
of  uninterrupted  residence  at  the  Retreat  ;  in  the  earlier  stages  the 
use  of  ordinary  alteratives,  sub-tonics,  and  milder  sedatives,  etc.  ; 
throughout  all,  persistent  rest  both  of  mind  and  body  ;  relief  from 
all  duties  and  worries,  with  all  possible  cheerful  surroundings  and 
heart-cheering  influences  ;  diversions,  in-doors  and  out-of-doors  ;  in 
brief,  those  social  and  genial  remedies  which  I  have  elsewhere  more 
minutely  described,  and  in  which  my  prolonged  experience  has  in- 
creased my  confidence.  My  acquaintance  with  this  interesting  pa- 
tient ceased  with  my  record  of  "  Discharged  recovered."  Of  this  I 
am  confident :  with  a  reasonable  regard  to  prophylactics  in  her  future 
life,  and  fair  play  given  to  her  naturally  large  power  of  self-control, 
and  in  all  a  common-sense  profiting  from  the  sad  lesson  she  had 
learned  by  heart,  there  would  not  be  a  relapse  in  the  record  of  her  case. 

If  the  love  of  God,  faith  in  Christ,  and  the  hope  of  heaven  give 
way  under  the  delusions  of  insanity  to  hopeless  despair  and  the  cer- 
tainty of  endless  doom,  suicide  seems  a  natural  and  logical  sequence. 

The  peril  which  lurks  beneath  such  cases  demands  unwearied 
vigilance.  This  was  fairly  illustrated  by  another  patient  who  was 
one  of  a  class  before  described.  She  was  a  woman  of  more  than 
ordinary  intelligence  and  self-control  ;  she  was  broken  down  by  the 


40  THE   CURABILITY  OF  INSANITY. 

While,  to  the  insane,  all  their  delusions  are  as  real  as 
they  are,  in  truth,  imaginary,  none  but  those  who  are  in 
constant  converse  with  them  can  realize  how  material  is 
the  result  of  an  intimate  personal  intercourse.  I  daily 
saw  some  cloud  brightened,  some  terror  banished,  some 
wearisome  burden  lightened,  by  a  few  words  of  advice, 

"  accumulations  of  household  duties  and  drudgeries,  of  narrow  and 
near-sighted  economies,"  and  was  brought  to  the  Retreat  by  friends 
in  the  faint  hope  of  her  recovery.  It  was  an  extreme  case  of  melan- 
choly, demanding  constant  watchfulness.  In  due  time  the  apparent 
improvement  in  all  her  symptoms  gave  me  comforting  promise  of 
her  speedy  recovery  and  return  to  her  home,  where  she  was  greatly 
needed.  My  family  residence  was  on  the  lawn  at  a  little  distance 
from  the  Institution.  Parties  of  our  convalescent  patients  were  our 
frequent  social  visitors.  She  joined  the  party  one  evening,  and  this 
her  first  visit  appeared  to  be  greatly  enjoyed  ;  no  one  of  all  seemed 
more  truly  convalescent.  As  the  party  was  about  returning  to  the 
Retreat,  her  hostess,  learning  that  a  storm  had  suddenly  come  up, 
and  seeing  her  need  of  warmer  wraps,  sent  up  for  a  shawl,  and 
wrapped  it  carefully  round  her,  adding  some  brief  words.  Her 
health  was  soon  confirmed,  and  she  returned  home.  A  year  or  two 
afterwards,  meeting  her  hostess  in  the  city,  she  ran  up  to  her  with 
many  expressions  of  grateful  remembrance.  "  Excuse  me,  I  do  not 
remember  you,"  was  the  answer.  "  Oh  !  I  don't  wonder  at  that  ;  I 
am  so  changed  since  I  saw  you.  Don't  you  remember  inviting  me 
to  your  house  one  evening,  and,  as  we  were  about  to  return  to  the 
Retreat,  being  told  that  a  heavy  storm  had  come  up,  you  brought 
down  a  beautiful  shawl  and  wrapped  it  carefully  round  nie.  I  can 
never  forget  it ;  let  me  tell  you — before  coming  over  to  your  house  I 
had  made  up  my  mind  to  commit  suicide  that  very  night.  I  had  for 
a  long  time  believed  that  God  had  blotted  me  out  of  the  book  of  his 
remembrance,  and  the  quicker  I  met  my  fate  the  better  ;  that  my 
husband  would  be  happier  with  another  wife  ;  my  children  with  an- 
other mother.  I  knew  I  was  watched  pretty  closely  all  the  time,  but 
I  had  fixed  it  so  that  I  should  certainly  have  succeeded.  After  I  had 
gone  back  to  the  Retreat,  thinking  over  what  a  nice  time  I  had  had 
at  your  house,  all  at  once  it  came  over  me.  '  What  cati  all  this 
mean?  this  lady  to  invite  me,  treat  me  so  kindly,  and  then  wrap  her 
beautiful  shawl  so  carefully  about  me,  lest  I  should  catch  cold  and  be 
sick,  why  God  cannot  have  forsaken  me  ;  I  can't  be  such  a  sinner ; 
how  foolish,  how  really  crazy  I  must  have  been  to  think  so  ! '  From 
that  moment  I  was  right.     And  now  !  I  am  so  happy  !  " 


THE    CURABILITY  OF  INSANITY.  4 1 

of  cheer,  of  consolation,  or  of  sympathy.  That  asylum 
for  the  insane  is  poorly  cared  for  where  the  wants  of  the 
body  are  alone  abundantly  supplied,  while  the  cravings 
of  the  heart  are  left  unappeased.  Far  better,  in  my  view, 
to  banish  all  other  remedies  from  the  wards  of  such  an 
asylum,  than  to  leave  them  destitute  of  that  practical. 

In  connection  with  the  two  preceding  cases,  I  here  may  well  intro- 
duce the  partial  history  of  one  more — another  vivid  ilkistration  of  this, 
the  saddest  of  all  forms  of  mental  disease — melancholia.  Unfortu- 
nately, the  writer  of  the  following  letter,  immediately  after  its  recep- 
tion, was  placed  outside  of  my  aid,  but  never  outside  of  my  deepest 
sympathy  : 

"  Dr.  Butler  : — Will  you  allow  yourself  to  be  interested  in  a 
stranger  who  has  been  attracted  towards  you  by  some  remarks  in  an 
article  on  the  treatment  of  insanity  ?  Long  years  ago  (nearly  twenty) 
a  deep  dark  cloud  settled  on  my  spirit.  I  cannot  find  the  daylight  ; 
midnight  envelopes  me  ;  a  weight  of  suffering  oppresses  me.  The 
sense  of  being  is  pain.  I  can  conceive  of  no  circumstance  that  could 
make  existence  precious,  an  habitual  blessing,  I  seem  to  be  in  a 
dreary  dream,  from  which  I  cannot  awake.  I  move  about  among 
men,  but  not  of  them  ;  nothing  makes  a  deep,  abiding  impression, 
becoming  part  of  my  nature,  and  arousing  all  my  soul.  Things 
come  and  go,  and  almost  every  thing  is  intangible,  I  am  not  a  young 
romantic  girl  ;  I  am  over  thirty  years  of  age,  but  alas  !  I  know  no^ 
hozv  to  live  ;  I  die  a  living  death.  What  can  furnish  interest,  mo- 
tion, object,  to  fill  the  abyss  of  the  human  soul? 

"What  am  I? 
An  infant  crying  in  the  night, 
An  infant  crying  for  the  light, 
And  with  no  language  but  a  or)-.' 

"  It  seems  sometimes  as  if  I  was  almost  beside  myself.  I  have  such  a 
profound  sense  of  want  of  adaptation  to  any  thing.  I  am  a  stranger  in 
a  strange  land  ;  I  cannot  do  life's  work  ;  my  sinews  are  cut  ;  my  hands 
drop  at  my  side.  I  am  a  poor  crushed  spirit,  staggering  sometimes  under 
the  load  of  life.  Of  course  I  have  not  sufferecl  this  without  looking  up- 
ward ;  but  all  in  that  direction  is  total  darkness.  The  whole  realm  of 
Christianity  is  a  terra  incognita  to  me  ;  my  knowledge  of  the  system  is 
simply  historical.  Sermons,  reading,  the  instructions  of  Christians, 
are  all  unavailing.  My  deepest  prayer  is  an  agonized  cry  for  help  to 
the  'Unknown  God.'     My  religious  consciousness  has  never  in  my 


42  THE    CURABILITY  OF  INSANITY, 

personal  sympathy,  whose  hearty  sincerity  so  directly 
tends  to  the  larger  development  of  hopefulness  and  self- 
control. 

In  some  varieties  of  this  physical  disease  (insanity) 
some  articles  of  the  7nateria  viedica  are,  in  my  opinion, 
essential  to  speedy  or  to  permanent  cure  ;  in  many  more, 

life  been  awakened.  I  have  not  the  slightest  realization  of  the  re- 
lation between  the  finite  spirit  and  the  Infinite, — my  soul  and  its 
Creator.  When  I  say  :  '  Is  there  a  great  Being  who  knows  all  I  suf- 
fer, who  cares  forme,  and  who  is  deterred  by  adequate  reasons  from 
coming  to  my  aid  ?  '  and  receive  this  reply  :  '  There  is  a  great  Being 
who  is  deterred  from  helping  you,  till  you  come  to  Christ'  I  feel 
utterly  powerless.  I  can  utter  a  cry  of  vague,  undefined  want  ;  but 
when  I  am  bidden  to  'believe'  which  means  to  exercise  towards 
Christ  adoring,  trusting  affection,  I  know  nothing  about  the  matter  ; 
I  can  see  nothing,  do  nothing.  If  you  put  a  stone  on  the  head  of  a 
plant  looking  up  for  the  free  air  and  sunlight,  if  you  do  not  crush  it 
out  of  existence  do  you  not  make  it  a  living  tomb  ?  Is  there  vitality 
for  the  human  soul  ?  Is  there  a  world  of  life  and  activity  and  pleas- 
urable existence?  Shall  I  ever  breathe  its  atmosphere?  Must  to 
'suffer  and  be  still 'be  my  life's  work?  Must  I  go  on,  crushed, 
paralyzed,  benumbed,  till  body  and  spirit  separate  ?  If  God  '  is  not 
willing  that  any  should  perish,'  must  I  die  to  gain  my  first  conception 
of  happiness?  Professionally,  is  not  this  an  abnormal  condition? 
^What  is  the  matter  with  me?  Is  there  any  hope  for  me?  Am  I  not 
the  victim  of  mental  disease  ?  Do  I  not  speak  simple  truth  when  I  say 
I  have  no  power  to  rise,  throw  off  this  nightmare,  enter  into  life's 
labor,  respond  to  its  relations,  meet  its  obligations,  and  enjoy 
existence  ? 

"  I  am  not  well  ;  my  back  is  not  strong  ;  my  system  wants  healthful 
tone  and  vigor  ;  I  have  habitual  dyspepsia  ;  it  is  an  uneasiness  and 
lack  of  vitality  of  the  stomach  and  want  of  digestive  power,  but  not 
habitually  attended  with  constipation.  I  remember  that  some  such 
derangements  of  health  were  felt  soon  after  my  soul  sunk  down  op- 
pressed Ijy  this  inner  suffering. 

"And  now,  have  I  touched  your  sympathy  for  a  deeply  tried  fellow- 
being  ?  Can  you  do  any  thing  for  me  in  the  way  of  suggestion  ?  Is  it 
at  all  probable  that  I  shall  ever  Ijc,  do,  enjoy,  any  thing  as  others  may  ? 
Will  I  live  on  and  on  in  the  darkness  and  pain,  do  you  suppo>-e,  and 
when  from  old  age  or  disease  '  the  weary  wheels  of  life  stand  still,' 
must  I  fear  that  I  will  close  my  eyes  on  this  dreary  ante-chamber  of 
being,  and  '  take  a  leap  in  the  dark  '  ?  " 


THE    CURABILITY  OF  INSANITY.  43 

they  are  useful,  soothing,  pleasant  adjuvants  ;  but  these 
moral  means  are  so  pleasant  in  the  using,  they  so  soothe 
the  heart  weary  with  long  waiting  for  health  and  home, 
banishing,  for  a  time  at  least,  those  delusions  which 
make  the  worse  appear  the  better  reason.     I  claim  that 

A  lady,  the  daughter  of  a  merchant,  married,  and  a  connection  in 
business  was  formed  between  the  father  and  the  husband. 

In  a  short  time  the  embarrassment  of  the  former  involved  the 
whole  fortune  of  the  latter  ;  and  in  about  a  year  the  young  couple 
were  left  without  any  provision,  with  one  child  and  the  expectation  of 
another.  What  added  to  her  affliction  was,  the  trouble  of  her  pa- 
rents and  the  other  children,  for  all  of  whom  she  had  the  tenderest 
affection.  I  knew  this  lady  from  her  childhood,  She  never  had  a 
good  constitution,  but  had  always  been  subject  to  severe  headaches 
and  other  corporeal  ailments.  A  near  and  dear  relative  with  whom 
she  corresponded,  in  the  attempt  to  console,  very  vehemently  ex- 
horted her  to  seek  consolation  in  religion,  which  advice  she  enforced 
by  such  spiritual  arguments  as  she  thought  necessary.  Unfortunately, 
these  arguments  were  intermixed  with  many  abstract  doctrinal  points 
which  were  new  to  the  sufferer.  In  the  adaptation  of  them  to  her 
own  case  she  felt  great  perplexity.  Instead,  therefore,  of  deriving 
consolation,  she  at  last  adopted,  without  due  examination,  the  most 
dangerous  sophisms  for  truths.  It  was  soon  perceived  that  her  rea- 
son was  w^avering  ;  shortly  complete  insanity  was  developed.  In 
this  state  she  was  brought  to  London,  and  consigned  to  my  direction. 
She  was  then  only  twenty-four  years  of  age.  There  was  evidently 
great  constitutional  as  well  as  mental  disorder.  In  a  few  months  I 
had  the  satisfaction  to  see  her  health  much  improved,  and  every  il- 
lusion by  degrees  vanish.  In  a  few  wrecks  she  returned  to  the  bosom 
of  her  family. 

Never,  probably,  has  any  one  who  had  been  insane  been  exposed 
to  greater  risk  of  relapse  ;  yet  after  the  first  struggle,  and  experien- 
cing some  threatening  symptoms,  she  rallied. 

Then  it  was  she  experienced  real  consolation  from  religion.  Her 
recent  spiritual  delusions  had  passed  away.  If  she  remembered  the 
new  lights  which  had  so  fatally  misled  her,  and  finally  absorbed  her 
reasoning  faculties,  she  was  aware  of  their  dangerous  effect  ;  and  re- 
lying solely  on  those  principles  from  which  she  had  formerly  always 
derived  satisfaction  and  support,  she  was  enabled  to  preserve  her 
reason  and  attain  a  state  of  comparative  happiness. 

The  above  is  given  by  Dr.  Burrows  of  London,  in  Barlow's  "  On 
Man's  Power  over  Himself  to  Prevent  or  Control  Insanity,"  page  92. 


44  THE   CURABILITY  OF  INSANITY. 

both  of  these  remedies  are  essential  to  the  best  curative 

treatment. 

Amid   the    weary  hours  of  sad  or  fearful  imagining, 

music,  games,  all  social  or  intellectural  gatherings  and 

recreations,  excursions,  changes  of  scene  and  localities, 

art,  in  its  various  forms  of  beauty,   pictures,  engravings, 

statuary,  and,  above   all  other  things,  flowers — they  are 

ever  most  welcome. 

Dr.  Poole,  of  the  Montrose  Asylum,  says  : 

After  the  obliteration  of  reason,  many  of  the  highest  feelings  of 
our  nature  remain,  to  which  a  successful  appeal  may  be  made,  and 
those  by  which  we  are  connected  with  a  higher  sphere  of  existence, 
admit  as  readily  of  being  awakened,  on  the  proper  object  being  pre- 
sented to  them,  as  the  ordinary  passions  under  which  the  lunatic  acts. 
Their  influence  is,  in  the  highest  degree,  consoling,  and  congenial  to 
the  return  to  mental  strength  and  serenity  ;  the  effects  in  each  indi- 
vidual are  probably  as  different  as  in  the  members  of  an  ordinary 
congregation. 

I  cannot  forbear  quoting  the  testimony  of  the  Rev. 
Dr.  Gallaudet,  for  many  years  chaplain  of  the  Retreat  : 

How  many  torpid  sensibilities  have  I  seen  awakened  to  respond  to 
the  impressions  of  the  fair,  the  beautiful,  and  the  good  ;  how  many 
consciences  aroused  to  a  sense  of  the  right  and  the  wrong,  so  as  to 
produce  the  power  of  self-control  and  of  proper  conduct  ;  how  many 
slumbering  domestic  and  social  affections  kindled  up  into  their  for- 
mer activity  ;  how  many  religious  despondencies,  sometimes  deepen- 
ing into  despair,  changed  into  the  serenity  of  Christian  hope  ;  how 
many  suicidal  designs  forever  abandoned,  because  life  had  become  a 
pleasure,  instead  of  a  burden  too  heavy  to  be  borne  ;  how  many  pray- 
ers revived  at  the  altars  of  private  and  public  devotion  ;  how  many 
kindly  charities  of  the  soul  breathing  forth,  once  more,  in  deeds  of 
self-denying  benevolence  ! 

Amid  the  vestiges  of  reason,  the  affections  and  sen- 


THE   CURABILITY  OF  INSANITY.  45 

sibilities  sometimes  exist  as  warmly  and  as  acute  as  ever, 
and,  in  many  cases,  the  same  high  and  ennobling  results 
may  be  attained  as  from  the  operation  of  similar  causes 
upon  individuals  under  ordinary  circumstances.  Leaving 
out  of  the  estimate  all  other  results,  my  fifty  years'  ex- 
perience, thirty-three  as  superintendent,  have  confirmed 
the  opmion,  early  expressed,  of  the  benefits  of  these  in- 
fluences as  remedial  agents.  Any  deviation  from  good 
order  and  propriety,  during  chapel  service,  has  been  no 
more  frequent  than  interruptions  from  impatient  and 
undisciplined  children  during  ''  meeting  "  in  the  country.' 

^  During  the  Rev.  Mr.  Gallaudet's  services  as  our  chaplain,  a  very 
insane  woman  was  admitted.  She  was  the  wife  of  a  well-to-do  far- 
mer, and  was  of  more  than  usual  intelligence,  of  kindly,  cheerful,  tem- 
perament, and  naturally  of  large  self-control.  She  had  broken  down 
under  the  too  common  influences  of  monotonous  overwork  and  worry. 
I  found  her  general  health  seriously  impaired.  She  was  excitable, 
impulsive,  indeed  utterly  out  of  reach  of  control.  Her  language  was 
profane  and  obscene  beyond  all  precedent  in  the  somewhat  large  ob- 
servation which  my  varied  fields  of  practice  had  given  me.  I  placed 
her  in  rigid  seclusion,  not  allowing  the  matron  or  the  nurses  in  my 
visit  to  be  exposed  to  such  foulness  of  words.  In  due  time  her  gen- 
eral physical  health  decidedly  improved.  She  had  a  good  appetite, 
and  slept  well ;  but  neither  persuasion  nor  reproof  could  tame  that 
unruly  member,  the  tongue.  My  hopes  of  speedy  recovery  were 
fading,  when  one  afternoon,  just  before  the  chapel  service,  her  nur.-e, 
passing  through  my  office,  remarked — not  as  a  request  to  be  heeded, 
but  as  something  strange  :  "  Mrs.  B.  wants  to  go  to  prayers."  Re- 
calling her  as  she  passed  out,  I  asked  :  "  Was  the  request  made  with- 
out any  suggestion  ?  Does  she  really  want  to  go  ?  If  so,  take  her  up 
with  you.  Sit  near  the  door,  and  watch  her  sharply.  If  she  says  a 
word,  hurry  her  out."  A  few  minutes'  reflection  convinced  me  that 
this  time  at  least  the  first  conclusion  was  not  a  wise  one.  A  few  evil 
words  from  the  poor  insane  woman  would  disgust  many  with  the 
chapel  services  ever  after.  But  as  the  bell  was  ringing  it  was  too 
late  to  revoke  the  order.  On  going  to  the  chapel  I  found  her  seated 
near  the  door.  She  gave  quiet  attention  to  the  whole  service,  and 
peaceably  retired.  Telling  her  the  next  morning  that  I  was  pleased 
to  see  how  quiet  she  was  in  the  chapel,  she  answered  :  "  The  nurse 
was  afraid  to  have  me  go."     "  Do  you  wonder,"  I  said,  "  talking  so 


46  THE   CURABILITY  OF  INSANITY. 

(I  must  remark  that  it  is  self-evident  that  the  chaplain 
should  be  like  the  assistant  physician,  the  direct  ap- 
pointee of  the  superintendent). 

We  are  largely  indebted  to  Dr.  Dewey,  of  Kankakee, 
111.,  for  a  most  timely  article  in  the  Alie7iist  and  Neurol- 
ogist of  January,  1884,  giving  an  exposition  of  the  rise 
and  progress  of  the  separate  systems  of  "  Congregate  " 
and  ''  Segregate  "  buildings  for  the  insane,  /.  ^.,  the  con- 
nection or  separation  of  the  different  classes.  In  a  brief 
recapitulation  of  the  lines  of  thought  in  general,  he  says  : 

1.  Institutions  for  the  insane  were  at  first  only  founded  for  public 
relief,  and  without  the  idea  of  benefit  to  the  insane. 

2.  It  has  always  been  a  too  general  impression  that  the  insane  are 
essentially  different  from  the  sane  in  every  thing,  instead  of  the  fact 
being  recognized  that  they  possess  natural  traits  and  activities,  which 
are,  however,  modified  through  the  agency  of  disease,  wrongly  di- 
rected or  held  in  abeyance  ;  and  this  mistake  has  been  very  mischiev- 
ous in  its  effects  upon  the  provision  for  them,  preventing  a  supply  of 
a  natural  and  domestic  abode,  adapted  to  the  varying  severity  of  dif- 
ferent degrees  and  kinds  of  insanity. 

badly  as  you  have  done  ? "  "Oh!  doctor,"  she  said,  "you  never 
need  fear  that.  I  know  better  than  to  use  unholy  words  in  God's  holy 
house."  I  "  improved  the  occasion  "  by  leading  her  thoughts  back  : 
"  What  would  your  good  friends  at  home  think  of  you,"  I  said,  "  to 
hear  you  talk  as  you  do — your  good  minister's  wife,  and  the  deacons, 
your  husband,  your  own  children,  and  all  the  good  folks  who,  you 
say,  think  so  much  of  you  ?  "  This  appeal  subdued  her,  hopefully  ! 
"Now,"  I  added,  "  if  you  behave  like  a  lady  in  God's  house,  you 
can  do  so  everywhere  else.  You  can  do  so  with  those  good  folks  up- 
stairs who  long  to  have  you  with  them,  and  in  a  nicer  room  than 
this,  and  away  from  these  poor  unhappy  people  whom  you  can't 
like  !  "  Asking  it  also  as  a  great  favor  to  myself,  I  won  the  promise 
of  better  behavior,  and  only  good  words.  Bating  some  few  inci- 
dental and  brief  relapses,  her  promises  were  faithfully  kept.  After 
a  few  weeks  of  pleasant  and  uninterrupted  association  with  quiet  and 
convalescing  patients,  her  restoration  to  health,  and  her  return  home 
was  a  cheering  illustration  of  the  principle  we  are  advocating. 


THE    CURABILITY  OF  INSANITY.  47 

3.  The  essential  difference  between  an  institution  for  the  insane 
and  all  other  institutions,  in  confining  and  controlling  those  who  are 
held  as  prisoners  without  being  guilty  of  any  offence,  and  who  are 
entitled  to  the  utmost  privileges  and  consideration  of  their  wants, 
without  possessing  in  the  eye  of  the  law  or  in  the  exercise  of  reason 
the  ability  to  enforce  their  claims,  was  long  overlooked,  but  has 
come  to  be  more  fully  appreciated. 

4.  Gradually  insanity  has  come  to  be  recognized  as  a  disease, 
hospitals  have  been  founded,  mainly  for  curative  treatment,  and  the 
congregate  asylum  has  been  developed,  admirable  for  its  purpose, 
but  not  adapted  for  universal  application  to  the  entire  body  of  the 
insane. 

5.  Finally,  the  infinite  variations  among  the  insane,  in  the  mani- 
fold forms  of  the  disease  ;  in  the  degree  of  reason  and  self-control 
possessed  by  different  individuals  or  characterizing  different  groups 
of  the  insane  as  a  whole  ;  in  the  various  classes  of  private  and  pau- 
per, criminal  and  innocent,  epileptic,  inebriate,  etc.,  are  beginning 
to  be  more  fully  understood  by  the  public  and  the  medical  profession, 
and  a  variety  is  being  introduced  in  the  erection  of  buildings,  as  to 
location  and  internal  arrangement,  by  which  an  appropriate  environ- 
ment for  each  and  all  is  sought  to  be  attained,  while  at  the  same 
time,  the  opinion  gains  ground  that  the  domestic  or  "segregate,"  as 
contrasted  with  the  "  congregate  "  or  institution  idea,  should  prevail 
for  a  large  portion,  in  providing  for  them  economical  and  substantial 
buildings,  with  as  much  of  the  house-like  and  home-like  character  as 
in  each  instance  the  fact  of  insanity  would  permit. 

We  have  here  one  of  the  many  good  evidences  that 
from  the  first  of  the  organization  of  the  Association,  its 
members  have  accepted  the  teachings  of  Dr.  Arnold, 
that  "  Nothing  is  so  wrong  as  the  strain  to  keep  things 
fixed  when  the  whole  organization  of  law  and  order  is 
one  of  eternal  progress." 

Originally  the  congregate  system  was  naturally  adopted 
in  the  State  lunatic  hospitals,  as  promising  to  be  adequate 
to  all  necessities  then  known.     The  pressure  for  admis- 


48  THE    CURABILITY  OF  INSANITY. 

sion  bevond  the  original  estimates  was  as  unexpected  as 
it  was  irresistible.  The  suffering  applicants  would  not 
and  could  not  be  denied.  Experience  alone  can  measure 
the  painful  perplexities  attending  the  management  of  a 
lunatic  hospital,  and  the  positive  evils  resulting  from  an 
overcrowded  condition.  In  this  connection  I  cannot 
forbear  recording  my  admiration  of  those  my  justly 
honored  fellow-members  of  the  Association  of  Super- 
intendents, whose  administration  under  their  embar- 
rassments, often  with  narrow  means,  has  met  with  such 
grand  success. 

Among  the  thousands  of  the  varied  classes  of  the  in- 
sane whom  the  broad  charities  of  the  States  have  so 
mercifully  sheltered,  there  are  many  old  and  hopeless 
cases,  without  friends  or  kindred,  the  daily  care  of  whose 
lives  has  hitherto  been  often  calculated  with  a  rigid 
economy  and  scant  sympathy,  who  have  a  right  to  claim 
from  their  fellow-men  a  quiet  and  kindly  resting-place 
on  their  way  to  the  grave.  Some  of  them  are  truly  good 
men  and  women,  though  the  moral  accountability  of 
their  lives  is  at  an  end.  ''  Possible  angels  in  another 
life  "  (as  some  one  aptly  termed  them),  they  are  waiting, 
sometimes  in  tumult,  sometimes  in  fear,  rarely  in  peace, 
that  conclusion  of  life  which  may  be  to  them  the  prelude 
of  a  better  existence.  1  never  looked  upon  this  class 
without  hearty  interest.  As  we  scatter  flowers  over  the 
graves  of  our  friends,  and  keep  their  resting-places  in 
decency  and  order,  so  should  we  care  for  those  ever 
worthy  of  our  love,  who  were  never  more  in  need  of  our 
thoughtful  and  practical  sympathy. 

«  John  S.  Butler, 


APPENDIX. 


(i.)  Page  S.  In  1845,  that  enlightened  and  persevering  philanthro- 
pist, Lord  Ashley,  to  whom  the  poor  of  England  are  greatly  indebted 
for  his  able  advocacy  of  their  interest,  submitted  to  the  House  of  Com- 
mons two  bills  "  for  the  better  care  of  the  insane."  On  presenting 
them  for  consideration  he  made  an  able  speech  replete  with  valuable 
information  (Editor,  yournal  of  Insanity').  "  It  seems  unnecessary," 
he  said,  "  that  I  should  weary  the  House  further,  to  enforce  upon  an 
assembly  of  educated,  humane,  and  liberal-minded  men  the  necessity 
for  making  provisions  for  those  unhappy  and  destitute  beings,  who, 
by  a  wise  though  inscrutable  dispensation  of  Providence,  have  been 
made  subject  to  this  awful  calamity,  and  whose  suffering  and  helpless 
condition  demands  that  they  should  receive  an  unusual  share  of  sym- 
pathy from  every  one  of  us.  But  it  is  remarkable  how  slow  and 
tedious  has  been  the  process  whereby  we  have  arrived  at  the  rational 
and  kind  mode  of  treatment  which  now  appears  to  be  recommended 
to  all  of  us,  not  only  by  the  dictates  of  humanity,  but  also  by  com- 
mon-sense. Until  the  period  of  the  Reformation  there  is  not  a  single 
instance  of  a  lunatic  asylum  being  established.  Persons  of  station 
and  wealth  were  confined  in  their  own  houses  ;  and  whips,  chains, 
darkness,  and  solitude  were  the  approved  remedies.  That  practice 
has  indeed  descended  to  our  own  times  ;  and  Ur.  Conolly  states  that 
he  has  formerly  witnessed  '  humane  English  phy>icians  daily  con- 
templating helpless  insane  patients  bound  hand  and  foot,  and  neck 
and  waist,  in  illness,  in  pain,  and  in  the  agonies  of  death,  without 
one  single  touch  of  compunction,  or  the  slightest  approach  to  feeling 
of  acting  either  cruelly  or  unwisely  ;  they  thought  it  impossible  to 
manage  insane  people  any  other  way.'  "     It  belonged  to  the  French 

49 


50  THE   CURABILITY  OF  INSANITY. 

nation,  to  the  genius  of  French  professors,  first  to  make  this  mighty 
advance  in  the  cause  of  humanity.  It  was  reserved  for  M.  Pinel,  the 
great  physician,  to  achieve  this  great  work. 

He  undertook  what  appeared  to  be  the  rash  enterprise  of  liberating 
the  dangerous  lunatics  of  the  Bicetre.'  He  made  application  to 
the  Commune  for  permission.  Couthon  offered  to  accompany  him 
to  the  great  Bedlam  of  France.  They  were  received  by  a  confused 
noise.  The  yells  and  angry  vociferations  of  three  hundred  maniacs 
mixing  their  sounds  with  the  echo  of  clanking  chains  and  fetters 
through  the  dark  and  dreary  vaults  of  the  prison.  Couthon  turned 
away  with  horror,  but  permitted  the  physician  to  incur  the  risk  of 
his  undertaking. 

There  were  fifty  who,  he  (Pinel)  considered,  might  without  danger 
to  the  others  be  unchained  ;  and  he  began  by  releasing  twelve,  with 
the  sole  precaution  of  having  previously  prepared  the  same  number  of 
strong  waistcoats  with  long  sleeves,  which  could  be  tied  behind  the 
back  if  necessary.  The  first  man  on  whom  the  experiment  was  to 
be  tried  was  an  English  captain,  whose  history  no  one  knew,  as  he 
had  been  in  chains  forty  years.  He  was  thought  to  be  one  of  the 
most  furious  among  them.  The  keepers  approached  him  with  cau- 
tion, as  he  had,  in  a  fit  of  fury,  killed  one  of  them  on  the  spot,  with 
a  blow  of  his  manacles.  He  was  chained  more  rigorously  than  any 
of  the  others,  Pinel  entered  his  cell  unattended,  and  calmly  said  to 
him  :  "  Captain,  I  will  order  your  chains  to  be  taken  off,  and  give 
you  liberty  to  walk  in  the  court,  if  you  will  promise  me  to  behave 
well,  and  injure  no  one."  "Yes,  I  promise  you,"  said  the  maniac, 
"  but  you  are  laughing  at  me  ;  you  are  all  too  much  afraid  of  me." 
"I  have  six  men,"  answered  Pinel,  "ready  to  enforce  my  com- 
mands, if  necessary.  Believe  me,  then,  on  my  word,  I  will  give  you 
your  liberty  if  you  will  put  on  this  waistcoat."  He  submitted  to  this 
willingly,  without  a  word.  His  chains  were  removed,  and  the  keep- 
ers retired,  leaving  the  door  of  the  cell  open.  He  raised  himself 
many  times  from  his  seat,  but  fell  again  on  it,  for  he  had  been  in  a 
sitting  posture  so  long  that  he  had  lost  the  use  of  his  limbs.     In  a 

*  In  "  Pinel,  a  Biographical  Study,"  read  before  the  Academy  of  Sciences,  by 
Casimer  Pinel  (his  nephew),  we  find  this  thrilling  relation. 


THE   CURABILITY  OF  INSANITY.  5  I 

quarter  of  an  hour  he  succeeded  in  maintaining  his  balance,  and, 
with  tottering  steps,  came  to  the  door  of  his  dark  cell.  His  first 
look  was  at  the  sky,  and  he  cried  out  enthusiastically  :  "  How  beau- 
tiful !  "  During  the  rest  of  the  day  he  was  constantly  in  motion, 
walking  up  and  down  the  staircases,  and  uttering  short  exclamations 
of  delight.  In  the  evening  he  returned  of  his  own  accord  to  his  cell, 
where  a  better  bed  than  he  had  been  accustomed  to  had  been  pre- 
pared for  him,  and  he  slept  tranquilly.  During  the  two  succeeding 
years,  which  he  spent  in  the  Bicetre,  he  had  no  return  of  his  previous 
paroxysms,  but  even  rendered  himself  useful  by  exercising  a  kind  of 
authority  over  the  insane  patients,  whom  he  ruled  in  his  own  fashion. 

It  was  spread  abroad  that  Pinel  had  released  the  lunatics  from 
their  fetters  with  bad  intentions,  and  under  this  pretext  a  furious 
mob  one  day  brought  him  ^^  a  la  lanterned  Chevinge,  an  old  soldier 
of  the  French  Guards,  rescued  him  out  of  their  hands,  and  thus  saved 
his  life.  This  man  was  one  of  those  lunatics  liberated  by  Pinel, 
afterwards  cured,  and  ultimately  taken  into  his  service. 

It  is  elsewhere  recorded  that  for  months  after  his  rescue  of  Pinel, 
he  procured  all  the  needed  supplies  of  the  Bicetre,  under  the  direc- 
tion of  the  doctor,  who  did  not  dare  to  be  seen  in  the  street. 

In  his  comprehensive  and  interesting  history  of  the  insane,  Dr. 
Hack  Tuke  quotes  from  Dr.  Pliny  Earle  {^American  yourtial  of 
Insanity,  April,  1856),  who  says:  "It  is  now  very  fully  demon- 
strated that  the  idea  of  the  amelioration  of  the  condition  of  the 
insane  was  original  with  Pinel  and  Tuke,  and  that  for  some  time 
they  were  actively  pursuing  their  object,  each  uninformed  of  the 
action  of  the  other.  It  is  no  new  thing  for  inventions,  discoveries, 
and  innovations  upon  traditionary  practices  to  originate  almost  sim- 
ultaneously in  more  than  one  place,  showing  that  they  are  called  for 
by  the  times,  that  they  are  developments  of  science  and  humanity, 
necessary  evolutions  of  the  human  mind  in  its  progress  towards  the 
unattainable  perfect,  rather  than  what  may  be  termed  a  gigantic  or 
monstrous  production  of  one  intellectual  genius.  Each  perceived 
the  wretchedness,  the  misery,  the  suffering  of  the  insane  around 
him  ;  each  was  moved  to  compassion  ;  each  resolved  to  effect  a 
reform  in  their  treatment  ;  each  succeeded.  The  recognition  of 
services  to  humanity  is  due  to  each.     To  each  we  freely  accord  it." 


52  THE   CURABILITY  OF  INSANITY. 

Dr.  Ray,  in  the  same  journal,  speaks  of  the  founder  of  the  Retreat 
as  "clear-headed  and  warm-hearted,  one  who,  true  to  his  faith,  con- 
ceived the  idea  that  the  insane  as  well  as  the  sane  could  be  best 
managed  in  the  spirit  of  peace  and  good-will." 

(2.)  Page  23.  In  describing  the  Retreat  for  the  Insane  in  the 
yournal  of  Ifisaniiy  for  July,   1845,  page  67,  Dr,  Bingham  says  : 

"  From  the  report  of  the  Chaplain  we  make  the  following  extracts  : 

"  '  To  guard  against  relapse  also,  it  ought  never  to  be  forgotten,  is 
a  prominent  feature  of  complete  success  in  the  care  of  the  insane. 
Self-control,  prudence  in  observing  the  rules  of  health,  watchfulness 
in  avoiding  those  kinds  and  degrees  of  excitement  which  tend  to  pro- 
duce a  relapse,  calm  and  equable  feelings,  just  views  of  life,  a  con- 
scientious performance  of  duty,  regular,  useful,  and  encouraging 
employment,  cheerful  resolution  and  hope,  and,  above  all,  moral  and 
religious  principles, — these  should  be  cultivated  with  the  most  assid- 
uous care,  as  they  constitute  the  strongest  security  against  the  return 
of  the  distressing  malady.  That  institution  which  can  best  succeed 
in  furnishing  its  cured  and  discharged  patients  with  these  elements  of 
security  has  attained  one  of  the  highest  ends,  if  not  the  very  highest, 
to  be  allied  at  in  this  department  of  benevolent  effort.  To  do  this 
the  whole  man  must  be  put  right,  or  as  near  right  as  can  be.  Not 
only  medical  but  also  moral  and  religious  influences  must  be  brought 
to  bear  upon  him,  or  else  he  will  be  healed  but  in  part,  and  subse- 
quent irregularity,  or  even  deficiency,  in  the  working  of  one  portion 
of  his  system  may  again  derange  other  portions,  and  the  old,  or  som.e 
new  form,  perhaps,  of  mental  aberration  be  the  result.' 

"  These  we  consider  valuable  suggestions.  We  have  long  felt  and 
tauglit  that  '  we  had  not  done  a  patient  all  the  good  we  ought  by 
curing  him  of  one  attack,  but  that  we  should  endeavor  so  to  instruct 
him  that  he  may  prevent  another  ;  that  we  believed  in  man's  power 
over  himself  to  prevent  and  control  insanity  in  many  instances.' 

"  But  to  accomplish  this  men  need  instruction,  especially  those  pre- 
disposed to  insanity,  and  we  know  of  no  one  better  calculated  to  aid 
in  enlightening  all  such  on  this  important  subject  than  the  dis- 
tinguished Chaplain  to  the  Retreat,  and  we  indulge  the  hope  that  he 
will  prepare  a  work  on  the  topics  to  which  he  has  alluded,  embracing 
also  those  errors  in  education  and  in  the  moral  training  of  children 


THE  CURABILITY  OF  IMSAIS^ITY.  53 

and  youth  likely  to  dispose  them  to  violent  emotions,  and  ultimately 
to  insanity.  Such  a  work  is  much  needed,  and  would,  we  believe,  be 
of  great  utility." 

These  are  wise  and  timely  words.  This  application,  ever  needed, 
seems  of  late  less  efficiently  enforced.  The  ultimate  results  of 
typhus,  pneumonia,  and  especially  scarlet-fever  and  diphtheria,  in 
children,  would  be  far  less  favorable  if  the  danger  from  relapses  of 
these  insidious  diseases  were  not  explained  and  vigilantly  watched. 
The  marked  change  in  the  convalescence  from  insanity  increases  the 
inability  of  the  non-experts  to  measure  the  danger  which  may  remain. 
The  naturally  earnest  desire  of  both  friends  and  patients  to  hasten 
the  return  home,  with  the  frequent  sharp  economies  or  the  really 
narrow  pecuniary  means,  combines  to  defeat  the  cautions  of  the 
physician.  It  has  again  and  again  occurred  that  patients  thus  un- 
wisely removed  have  been  brought  back  within  a  few  weeks  or 
months,  in  most  cases  not  as  insane  as  on  the  first  admission.  Gen- 
erally their  experience  had  made  them  wiser.  Some  frankly  con- 
fessing their  mistake,  were  ready  to  give  the  institution  another  and 
fairer  trial.  In  equity  two  such  admissions  should  count  but  one. 
Such  lessons,  if  not  as  promptly  efficient  as  that  taught  by  the  "  old 
barn  "  (see  page  24),  often  proved  as  effectual. 

The  more  the  aspect  of  home  was  given  to  the  Retreat,  the  greater 
was  the  readiness  of  convalescents  to  remain,  in  the  good  hopes  of 
securing  a  more  thorough  and  permanent  recovery.  Sometimes 
when  this  had  been  secured,  the  patients,  finding  themselves  after 
leaving  us  giving  way  under  the  oppressions  and  unavoidable 
influences  of  their  own  home  lives,  have  come  back  for  some 
possible  relief,  and  have  found  it  to  their  present  content  in 
being  admitted  not  formally,  but  as  visitors  for  a  few  days  or 
weeks.  This  was  one  of  the  minor  but  happy  influences  of  the 
Retreat. 

Insanity  is  confessedly  a  most  formidable  disease.  The  great 
question  now  pressing  upon  us  comes  from  the  masses  of  incurables 
overcrowding  many  of  our  capacious  State  hospitals,  crippling  the 
means  of  remedial  treatment,  as  well  as  that  of  comfort.  How  shall 
this  multitude  be  cared  for,  and  how  shall  we  check  their  rapid  in- 
crease ?     In  my  belief  this  mass   of  human  beings,  hopeless  of  cure. 


54  THE   CURABILITY  OF  INSANITY. 

rightly  demanding  kindly  care,  come  far  more  frequently  from  the 
ignorance  or  neglect  of  scientifically  well-known  and  preventible 
causes  than  from  the  often  accepted  one  of  heredity.  Passing  by  the 
discussion  of  the  due  proportion  of  these  fruitful  causes,  we  must 
look  for  our  best  relief  in  the  future  to  the  higher  power  of  preven- 
tion, that  best  means  of  averting  insanity.  To  this,  better  than  to 
the  science  of  remedy,  we  may  confidently  look  for  the  instrument  to 
root  out  its  subtle  heritage. 

(3.)  Page  32.  In  his  introduction  to  Dr.  Jacobi's  ' '  Hospitals  for  the 
insane,"  1841,  Samuel  Tuke  says  :  "  The  reasons  which  Dr.  Jacobi 
assigns  for  restricting  establishments  for  the  insane  to  two  hundred 
patients  appear  to  us  very  satisfactory — this  number  being  considered 
as  being  mainly  of  the  curable  class." 

Dr.  Jacobi  strongly  condemns  the  practice  of  admitting  or  retain- 
ing in  such  a  hospital  those  incurable  lunatics  who  are  affected  with 
such  forms  of  insanity  as  may  render  them  highly  distressing  or  in- 
jurious to  those  who  are  yet  considered  curable. 

Mr.  Tuke  says  :  "I  had  many  years  ago  an  opportunity  of  seeing 
the  change  from  large  to  small  classes,  and  was  confirmed  by  it  in  the 
opinion  which  I  had  previously  formed  on  comparing  the  condition 
of  the  large  companies  of  patients  in  one  institution  with  the  smaller 
divisions  in  another. 

"  In  the  one  thirty  patients  were  frequently  found  in  one  division, 
in  the  other  the  number  in  each  room  rarely  if  ever  exceeded  ten. 
Here  I  generally  found  more  of  the  patients  engaged  in  some  useful 
or  amusing  employment.  Every  class  seemed  to  form  a  little  family. 
They  observed  each  other's  eccentricities  with  amusement  or  pity  ; 
they  were  interested  in  some  degree  in  each  other's  welfare,  and  con- 
tracted attachments  or  aversions. 

"  In  the  large  society  the  difference  of  character  was  very  striking. 
I  could  perceive  no  attachments,  and  very  little  observation  of  each 
other.  In  the  midst  of  society  every  one  seemed  in  solitude  ;  con- 
versation or  amusement  was  rarely  to  be  observed — employment 
never.  Each  individual  was  pursuing  his  own  busy  cogitations,  pa- 
cing with  restless  step  from  one  end  of  the  enclosure  to  the  other,  or 
lolling  in  slothful  apathy  upon  the  benches.  It  was  evident  that 
society  could  not  exist  in  such  a  crowd." 


THE  CURABILITY  OF  INSANITY..  55 

Some  may  be  interested  in  the  explanation  which  Dr.  Tuke  gives 
of  the  origin  of  the  familiar  term  "  Retreat  "  as  applied  to  a  lunatic 
asylum.  He  states  that  ' '  one  day  the  conversation  in  the  family  cir- 
cle turned  on  the  question  what  name  should  be  given  to  the  proposed 
institution,  when  my  grandmother,  who  was  very  much  interested  in 
the  establishment,  quickly  remarked  that  it  should  be  called  a  Re- 
treat. It  was  at  once  seen  that  feminine  instinct  had  solved  the 
question,  and  the  name  was  adopted  to  convey  the  idea  of  what  such 
an  institution  should  be,  namely, — a  place  in  which  the  unhappy 
might  find  a  refuge,  a  quiet  haven  in  which  the  shattered  bark  might 
find  the  means  of  reparation  or  of  safety." 

(4.)  Page  35.  Dr.  John  Brown,  the  well-known  author  of  "  Rab 
and  His  Friends, "  in  the  memoirs  of  his  father,  says  :  ' '  From  his  ner- 
vous system  and  his  brain  predominating  steadily  over  the  rest  of  his 
body,  he  was  habitually  excessive  in  his  professional  work.  Thus  it 
was,  and  thus  it  ever  must  be,  if  the  laws  of  our  bodily  constitution, 
laid  down  by  Him  who  knows  our  frame,  and  from  whom  our  substance 
is  not  hid,  are  set  at  naught,  knowingly  or  not — if  knowingly,  the 
act  is  so  much  more  spiritually  bad  ;  but  if  not,  it  is  still  punished 
with  the  same  unerring  nicety,  the  same  commensurate  meting  out  of 
the  penalty,  and  paying  '  in  full  tale.'  It  is  a  pitiful  and  sad  thing 
to  say,  but  if  my  father  had  not  been  a  prodigal  in  a  true,  but  very 
different  meaning,  if  he  had  not  spent  his  substance,  the  portion  of 
goods  that  fell  to  him,  the  capital  of  life  given  him  by  God,  in  what 
we  must  believe  to  have  been  needless,  and  therefore  preventable  ex- 
cess of  effort,  we  might  have  had  him  still  with  us,  shining  more  and 
more,  and  he  and  they  who  were  with  him  would  have  been  spared 
those  two  years  of  the  valley  of  the  shadow,  with  its  sharp  and  steady 
pain,  its  fallings  away  of  life,  its  longing  for  the  grave,  its  sleepless 
nights  and  days  of  weariness  and  languor,  the  full  expressions  of 
which  you  will  find  nowhere  but  in  the  Psalms  and  in  Job." 

"  I  have  often  found  that  the  more  the  nervous  centres  are  em- 
ployed in  those  offices  of  thought  and  feeling  the  most  removed  from 
material  objects, — the  more  the  nervous  energy  of  the  entire  nature 
is  concentrated,  engrossed,  and  used  up  in  such  offices,  so  much 
the  more,  therefore,  are  those  organs  of  the  body  which  preside  over 
that  organic  life  common  to   ourselves   and  the  lowest  worm   de- 


56 


THE   CURABILITY  OF  INSANITY. 


frauded  of  their  necessary  nervous  food  ;  and  being  in  the  organic 
and  not  in  the  animal  department,  and  having  no  voice  to  tell  of  their 
wants  or  wrongs  till  they  wake  up  and  annoy  their  neighbors  who 
have  a  voice,  that  is,  who  are  sensitive  to  pain,  they  may  have  been 
long  ill  before  they  come  into  the  sphere  of  consciousness.  This  is 
the  true  reason,  along  with  want  of  purity  and  change  of  air,  want 
of  exercise,  want  of  shifting  the  work  of  the  body,  why  clergymen, 
men  of  letters,  and  all  men  of  intense  mental  application  are  so  lia- 
ble to  be  affected  with  indigestion,  constipation,  lumbago,  and  low- 
ness  of  spirits,  black  bile,  melancholia.  The  brain  may  not  give 
way  for  long,  because  for  a  time  the  law  of  exercise  strengthens  it  ; 
it  is  fed  high,  gets  the  best  of  every  thing,  of  blood  and  nervous 
pabulum,  and  then  men  have  a  joy  in  the  victorious  work  of  their 
brains,  and  it  has  a  joy  of  its  own,  too,  which  deludes  and  misleads. 
All  this  happened  to  my  father.  He  had  no  formal  disease  when  he 
died,  no  structural  change  ;  the  mechanism  was  entire,  but  the  mo- 
tive power  was  gone,  it  was  expended.  The  silver  cord  was  not  so 
much  loosed  as  relaxed.  The  golden  bowl,  the  pitcher  at  the 
fountain,  the  wheel  at  the  cistern,  were  not  so  much  broken  as  emp- 
tied and  stayed.  The  clock  had  run  down  before  its  time,  and  there 
was  no  one  but  Him  who  first  wound  it  up  and  set  it  who  could 
wind  it  up  again  ;  and  this  He  does  not  do,  because  it  is  His  law — an 
express  injunction  from  Him — that  having  measured  out  to  His 
creatures  each  his  measure  of  life,  and  left  him  to  the  freedom  of  his 
own  will  and  the  regulations  of  his  reason.  He  also  leaves  him  to 
reap  as  he  sows.     .     .     . 

"  Hugh  Miller,  that  remarkable  man — who  stands  alongside  of 
Burns  and  Scott,  Chalmers  and  Carlyle,  the  foremost  Scotchmen  of 
their  time — in  his  life  a  noble  example  of  what  our  breed  can  pro- 
duce, of  what  energy,  honesty,  intensity,  and  genius  can  achieve  ; 
and  in  his  death  ('  by  suicide  ')•  a  terrible  example  of  that  revenge 
which  the  body  takes  upon  the  soul  when  l^rought  to  bay  by  its  inex- 
orable taskmaster.  I  need  say  no  more.  His  story  is  more  tragic 
than  any  tragedy.  Would  to  God  it  may  warn  those  who  come  after 
to  be  wise  in  time,  to  take  the  same — I  ask  no  more — care  of  their 
body,  which  is  their  servant,  their  beast  of  burden,  as  they  would  of 
their  horse.     .     .     .     Most  men  have,  and  almost  every  man  should 


THE    CURABILITY  OF  INSAXJTY.  57 

have,  a  hobby  ;  it  is  exercise  in  a  mild  way,  and  does  not  take  him 
away  from  home  :  it  diverts  him  ;  and  by  having  a  double  line  of 
rails,  he  can  manage  to  keep  the  permanent  way  in  good  condition. 
A  man  who  has  only  one  object  in  life,  only  one  line  of  rails,  who 
exercises  only  one  set  of  faculties,  and  these  only  in  one  way,  will 
wear  himself  out  much  sooner  than  a  man  who  shunts  himself  every 
now  and  then,  and  who  has  trains  coming  as  well  as  going  ;  who 
takes  in  as  well  as  gives  out," 

In  this  connection  the  following  extract  from  a  lecture  delivered 
some  years  ago  before  the  Young  Men's  Association  of  Utica  on  the 
physiology  of  the  brain,  by  Prof.  Coventry,  seems  to  be  in  good  and 
timely  order  : 

"  Vague  and  indistinct  notions  were  long  entertained  as  to  the  in- 
strumentality of  the  brain  in  mental  operation.  This  is  well  illus- 
trated by  the  following  q^uotation  from  Burton's  '  Anatomy  of 
Melancholy.'  It  is  from  the  original  writings  of  Marrilium  Fier- 
nus  :  '  Other  men  look  to  their  tools  :  a  painter  will  wash  his  pen- 
cils ;  a  smith  will  look  well  to  his  anvils,  hammers,  and  forge  ;  an 
husbandman  will  mend  his  plow  iron,  and  grind  his  hatchet  if  it  be 
dull  ;  a  falconer  or  huntsman  will  have  an  especial  care  of  his  hawks, 
hounds,  horses,  and  dogs  ;  a  musician  will  string  and  unstring  his 
lute.  Only  scholars  neglect  that  instrument  (their  brain  and  spirit  I 
mean)  which  they  daily  use,  and  by  which  they  range  all  over  the 
world,  and  which  by  much  study  is  consumed.  This  (he  says)  dries 
the  brain,  extinguishes  natural  heat,  and  whilst  the  spirits  are  intent 
on  meditation  above,  in  the  head,  the  stomach  and  liver  are  left  des- 
titute, and  thence  comes  black  blood,  crudities,  and  melancholy  ;  so 
that  sedentary  and  diligent  men,  for  the  most  part,  spend  their  for- 
tunes, lose  their  wits,  and  often  their  lives  also,  and  all  through  im- 
moderate pains  and  extraordinary  studies." 

We  may  smile  at  his  physiology,  but  so  far  as  he  represents  the 
effects  of  intense  application  of  the  mind  and  sedentary  habits,  he  is 
undoubtedly  correct,  and  shows  the  close  observer  of  nature.  The 
following,  taken  from  a  recent  number  of  the  London  Quarterly  Re- 
view, exhibits  the  modern  view  of  the  same  subject.  Speaking  of 
the  education  of  Lord  Dudley,  the  writer  observes  :  ' '  The  irritable 
susceptibility  of  the  brain  was  stimulated  at  the  expense  of  bodily 


58  THE    CURABILITY   OF  INSANITY. 

power  and  health.  His  foolish  teachers  took  a  pride  in  his  preco- 
cious progress  which  they  ought  to  have  kept  back.  They  watered 
the  forced  plant  with  the  blood  of  life.  They  encouraged  the  viola- 
tion of  nature's  laws,  which  are  not  to  be  broken  in  vain.  They  in- 
fringed the  condition  of  conjoint  moral  and  physical  existence. 
They  imprisoned  him  in  a  vicious  circle,  where  the  overworked  brain 
injured  the  stomach,  which  reacted  to  the  injury  of  the  brain.  They 
watched  the  slightest  deviation  from  the  rules  of  logic,  and  neglected 
those  of  dietetics,  to  which  the  former  are  a  farce.  They  taught  him 
no  exercises  but  those  of  Latin  ;  they  gave  him  a  Gradus  instead  of 
a  cricket  bat,  and  his  mind  became  too  keen  for  its  mortal  coil,  and 
the  foundation  was  laid  for  ill-health,  derangement  of  stomach, 
moral  pusillanimity,  irresolution,  lowness  of  spirits,  and  all  the  pro- 
tean miseries  of  nervous  disorders  by  which  his  afterlife  was  haunted. 

"  The  picture  drawn  of  Lord  Dudley's  education  has  its  counter- 
part in  every  day's  experience.  .  .  .  The  overwrought  and  over- 
stimulated  intellect  is  literally  nourished  with  the  blood  of  life.  The 
brain  is  inordinately  excited  at  the  expense  of  every  other  part  of 
the  system,  and  life  or  permanent  ill-health  is  too  often  the  penalty 
paid  for  this  violation  of  nature's  laws." 

Some  years  ago  there  was  published  in  London,  a  valuable  series 
of  * '  Small  Books  on  Great  Subjects,  Edited  by  a  Few  Well- Wishers 
to  Knowledge." 

Among  them  was  one  by  the  Rev.  John  Barlow,  of  London,  en- 
titled "  Man's  Power  over  Himself  to  Control  Insanity." 

To  the  3rd  edition  of  this  valuable  essay  I  am  greatly  indebted,  not 
only  for  the  timely  suggestions,  but  for  several  pertinent  quotations 
from  foreign  authorities. 

Mr.  Barlow  quotes'  with  hearty  commendation  Mr.  Gallaudet's 
testimony  to  the  beneficial  influence  of  the  religious  services  of  the 
patients  as  follows  : 

"  In  estimating  their  value  there  are  many  things  to  be  taken  into 
account  in  addition  to  their  spiritual  benefit  to  the  patient.  .  .  . 
Such  are  the  following  :  the  necessary  preparations  to  be  made  for 
attending  the  religious  exercises  in  a  becoming  manner,  and  which 

^  Report  of  the  Retreat  for  1846. 


THE   CURABILITY  OF  INSANITY.  59 

fill  up  a  portion  of  time  agreeably  and  profitably  ;  the  regular  return 
of  the  stated  hour  for  doing  this,  and  the  pleasant  anticipations  con- 
nected with  it  ;  the  change  of  scene  from  the  apartments  and  halls  to 
a  commodious,  cheerful,  and  tasteful  chapel,  there  to  unite  in  the 
worship  of  God  ;  the  social  feelings  induced  and  gratified,  the  wak- 
ing up  of  formerly  cherished  associations  and  habits  ;  the  soothing, 
consoling,  and  elevating  influence  of  sacred  music  ;  the  listening  in- 
telligently to  the  interesting  truths  of  the  word  of  God,  and  uniting 
with  the  heart  in  rendering  him  that  homage  which  is  his  just  due,  as 
is,  beyond  doubt,  the  case  with  not  a  few  of  the  patients  ;  the  success- 
ful exercise  of  self-control,  so  strikingly  and  constantly  exhibited  by 
those  who  need  to  exercise  it  ;  .  .  .  the  habits  of  punctuality, 
order,  and  decorum  which  they  acquire  in  going  to  and  retiring  from 
the  accustomed  place  of  their  devotions;  .  .  .  the  feeling  that  in 
all  this  they  are  treated  like  other  folks,  and  act  as  other  folks  do  ; 
and  the  subsequent  satisfaction,  a  part  of  our  common  nature,  which 
many  of  them  experience  in  the  reflection  that  they  have  performed 
an  important  duty.  .  .  .  All  this  is  frequently  and  abundantly 
confirmed  by  statements  on  the  part  of  restored  patients  before 
leaving  the  Retreat,  who  speak  with  gratitude  of  the  interest  they 
have  felt  in  the  religious  exercises,  and  of  the  comfort  and  benefit 
they  have  derived  from  them,  and  from  the  other  means  of  religious 
counsel  and  consolation  which  they  have  enjoyed." 


COLUMBIA   UNIVERSITY   LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing,  as 
pro\ided  by  the  library  rules  or  by  special  arrangement  with 
the  Librarian  in  charge.                                                                   ' 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

o 

MUi'H   I 

WP^PT 

T 

1     L~ll'^5 

. .     . 

A 

t 

>./ 

1 

1 

1 
1 

C28(28I>  lOOM 

.i^-.--^  <v-T«7i  w:...^x 

1 

Il^' 


. ,     RC602 
/    •'  •     B97 
"^  1887 

Curability  of  insanity^ 


:.yj^ 


SOUTH  PROPERTY 

INTERLIBRARY  LOAN 

1887 


